‘Missing Americans’ – Early deaths surge in the United States, and not just because of COVID-19

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More than 2 million Americans who died in 2020 and 2021 might still be alive today if the United States had mortality rates equal to those of other developed nations.

A new study examined how many deaths might have been averted, based on the averages of age-specific mortality rates of 21 other wealthy countries. Researchers found excess deaths “surged” during the COVID-19 pandemic, but the U.S. death rate had been diverging from those of other nations for decades.

The authors said the number of “Missing Americans” tallied more than 1 million in 2020 and almost 1.1 million in 2021. Analyzing figures dating back to 1933, the number of excess deaths has never been larger in the United States.

“The number of Missing Americans in recent years is unprecedented in modern times,” corresponding author Jacob Bor, ScD, said in a news release. Bor is associate professor of global health and epidemiology at the Boston University School of Public Health.

In 2020 and 2021, almost half of all the Missing Americans died younger than age 65, according to the study.

“Think of people you know who have passed away before reaching age 65. Statistically, half of them would still be alive if the U.S. had the mortality rates of our peers,” Bor said. “The US is experiencing a crisis of early death that is unique among wealthy nations.”

20th Century history

The researchers used figures from the Human Mortality Database and the U.S. Centers for Disease Control and Prevention.

The United States had lower mortality rates than peer countries from the 1930s to the 1950s. World War II had a “disproportionate mortality shock” on younger age groups in many of the nations in Europe and on Japan. In the mid-20th century, younger Americans had elevated mortality rates compared to other countries, while older Americans enjoyed a lower mortality rate. That pattern began shifting in the late 1970s.

“U.S. death rates began to diverge in the 1980s, and this divergence has accelerated in the 21st century,” the study said. The researchers estimated there were 622,534 excess deaths in 2019, capping a four-decade period with 11 million excess deaths from 1980 to 2019.

Root causes

Americans already were dying at higher rates than other nations when the COVID-19 pandemic emerged in 2020, while other countries were better positioned to weather the emergency phase of the pandemic and protect population health going forward. In 2021, almost 1.1 million missing Americans would have enjoyed an estimated 26.4 million additional years of life if they had lived. “High levels of excess U.S. mortality are likely to continue even as COVID mortality wanes,” the study said.

The mortality is not confined to one ethnic or racial group. Black and Native Americans have endured decades of structural racism that have led to disparities in wealth, education, housing, and health care, according to the study.

But the United States has a larger population of White people who made up about 2/3 of the missing Americans. People of all races and ethnicities live with government policies that are failing to address issues such as the opioid epidemic, gun violence, pollution, poverty, hunger, and workplace safety.

“We waste hundreds of billions each year on health insurers’ profits and paperwork, while tens of millions can’t afford medical care, healthy food, or a decent place to live,” study senior author Steffie Woolhandler, MD, MPH, said in the news release. Woolhandler is distinguished professor at the School of Urban Public Health at Hunter College, City University of New York. “Americans die younger than their counterparts elsewhere because when corporate profits conflict with health, our politicians side with the corporations.”

The authors acknowledged the estimate of missing Americans is a statistical construct and there is no way to know what deaths might have been averted. But examining other countries shows what is achievable in high-income countries, setting a benchmark to judge the United States.

The comparison nations were: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, Luxembourg, The Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, and the United Kingdom.

The study, “Missing Americans: Early death in the United States – 1933-2021,” was published in PNAS Nexus.