More Americans die avoidable deaths than citizens of any other high-income country

© jozefmicic - stock.adobe.com

Despite spending more on health care than any other country in the world, the United States is seeing a rising number of deaths that shouldn’t be happening.

That’s the unsettling conclusion of a new study published online Monday in JAMA Internal Medicine, which tracked so-called “avoidable mortality” across all 50 U.S. states, Washington, D.C., and 40 other high-income countries. The metric counts deaths before age 75 that could have been prevented through public health efforts or avoided with timely and effective medical care.

The findings reveal a striking pattern: from 2009 to 2019, every single U.S. state — and Washington, D.C. — saw its avoidable mortality rate increase. At the same time, most peer nations in the European Union (EU) and Organisation for Economic Co-operation and Development (OECD) saw those deaths decline.

In the years leading up to the COVID-19 pandemic, much of the developed world made steady progress in reducing preventable deaths. In the U.S., however, the trend moved sharply in the opposite direction.

West Virginia, for example, saw nearly 100 more avoidable deaths per 100,000 residents over the decade. Even the best-performing state, New York, recorded an increase.

The pandemic widened the gap even further. Nearly every country in the study saw a spike in avoidable mortality between 2019 and 2021 — but the increase in the U.S. was steeper, broader, and more deeply rooted. By 2021, only a few Northeastern states and Hawaii had managed to avoid a statistically significant surge in deaths. The rest of the country was hit hard, especially in places already struggling with high levels of preventable mortality before the pandemic.

While COVID-19 was a major driver, it wasn’t the only one. Much of the rise in U.S. deaths over the decade came from external causes — including drug overdoses, suicides, and traffic accidents. Drug-related deaths alone accounted for more than 70% of the increase in avoidable deaths from external causes between 2009 and 2019.

Meanwhile, countries like Lithuania, Latvia, and South Korea were making measurable progress. Some of the largest gains came from Eastern European nations that started with higher rates of avoidable mortality but closed the gap through what the study suggests were broad policy and public health shifts.

A deeper look at health spending only sharpened the contrast between the U.S. and its global peers. In other high-income countries, more investment in health care generally meant fewer avoidable deaths. In the U.S., that relationship simply didn’t hold.

Across American states, there was no meaningful connection between how much was spent and how well residents fared. States that poured more money into health care didn’t necessarily see fewer deaths from preventable or treatable causes.

In other countries, though, the link was clear: the more money they spent, the fewer avoidable deaths they saw.

That finding raises uncomfortable questions about how efficiently the U.S. uses its health care dollars — and whether spending alone can solve a worsening crisis.

The study’s authors noted that preventable deaths — those linked to public health and policy failures — were the largest contributors to the U.S. increase. These include deaths that could have been avoided through stronger safety laws, better mental health care, tighter substance-use policies, or more accessible preventive services.

Even treatable deaths — including those from sepsis or certain cancers — have ticked upward in many U.S. states, a sign that access to timely, high-quality care is still falling short for many patients.

The message, in short: this isn’t just a few struggling states dragging down the average. Every state is facing this problem — and the problem isn’t merely clinical. It’s systemic.