Despite the apparent parity in access to cutting-edge medical technologies, the U.S. has experienced a progressively widening mortality gap with comparable affluent nations. The study meticulously quantifies what it terms “excess deaths”—fatalities that arguably could have been averted if American mortality rates aligned with those of other wealthy countries. Notably, by 2022, all-cause mortality rates in the U.S. were approximately 38 percent higher than those observed among other HICs, translating to an estimated 12.7 million avoidable deaths within this period. These excess deaths, evocatively labeled “missing Americans,” starkly illustrate systemic health failures embedded within the nation’s social and economic fabric.

Delving into the pathology of this mortality gap, the researchers highlight cardiovascular disease as the leading cause of excess deaths almost every year during the study period. Diseases including heart disease, hypertension, and stroke collectively accounted for a large fraction of these additional deaths, signifying a persistent vulnerability in managing cardiometabolic health within the U.S. population. Moreover, metabolic disorders, such as diabetes and chronic kidney disease, displayed a concerning upward trajectory post-2010, further exacerbating the causes behind excess mortality. Mental health disorders, notably Alzheimer’s disease and related dementias, rose sharply particularly in the elderly demographic aged 85 years and above, underscoring a growing crisis in neurological health outcomes.

This research expands significantly on prior studies by incorporating a detailed cause-specific evaluation, employing robust methodologies such as mortality rate ratios, years of life lost, and excess death counts. By harnessing data from the World Health Organization Mortality Database and comparing U.S. mortality patterns with those of 17 other high-income nations—including Canada, France, Japan, and the United Kingdom—the investigators provide a holistic view of the excess mortality phenomenon. Their analytical rigor accounts for stratifications by age, sex, temporal trends, and cause of death, affording a nuanced understanding of the factors driving the U.S. mortality disadvantage.

Intriguingly, deaths relating to substance abuse, especially drug poisonings and alcohol-related diseases, emerged as critical contributors to excess deaths, predominantly among younger Americans under 45 years of age. The study draws attention to the severe escalation of drug-related fatalities, associated notably with the influx of fentanyl in the U.S. illicit drug supply after 2013. While these causes manifested alarming relative risks—as high as 7.48 times in drug poisonings compared to peer countries—they paradoxically represented a smaller share of overall excess deaths due to their concentration in younger demographics. The social determinants fueling these trends, including economic disenfranchisement and behavioral health disparities, are underscored as key intervention points.

Contrasting with the high rates in many categories, the U.S. showed superior performance relative to its peers regarding certain cancer types (excluding lung cancer) and influenza mortality. This suggests that strides in American medical innovation, screening, and treatment protocols have yielded tangible improvements in specific domains, although these are insufficient to offset the broader mortality challenges. The researchers emphasize that elevated death rates from homicide and HIV/AIDS, while much higher in the U.S. than in other HICs, contribute to a relatively modest fraction of excess mortality numbers.

COVID-19’s devastating impact is prominently documented in the study, with the pandemic years (2020-2022) witnessing an acute surge in excess deaths. The virus accounted for roughly 20 percent of U.S. excess deaths during its initial waves, coinciding with exacerbations of underlying chronic conditions. The interplay between the pandemic and preexisting health disparities likely amplified the excess mortality burden, reflecting systemic vulnerabilities in public health infrastructure and social safety nets.

The study also illuminates the critical importance of social determinants of health in shaping mortality patterns. Death certificates typically attribute causality to proximate causes, but underlying social and economic factors—such as income inequality, health care access, educational disparities, and neighborhood environments—play a pivotal role in influencing behavioral risk factors and, consequently, mortality risk. Addressing these foundational determinants emerges as a central recommendation by study authors to reverse the rising tide of preventable deaths.

One of the most provocative conclusions relates to the relative emphasis within U.S. public health discourse on “deaths of despair” (drug overdoses, suicides, and alcohol-related mortality). While these certainly contribute to the mortality gap, the researchers stress that cardiometabolic diseases represent a substantially larger proportion of excess deaths on an absolute scale. This insight pivots policy focus toward broader preventive strategies tackling hypertension, obesity, diabetes, and cardiovascular risk factors through systemic reform in health promotion and disease prevention.

Federal policy reform is deemed essential to ameliorate the excess mortality burden. The authors advocate for a multipronged approach that integrates evidence-based interventions targeting chronic disease management, substance abuse prevention, mental health support, and social equity. They recommend exploring health policies from peer countries that demonstrate more effective mortality mitigation despite comparable access to medical advancements. A strategic realignment of public health priorities and resource allocation, informed by such international comparisons, might provide a roadmap to enhancing U.S. population health.

Innovative therapeutics, including novel agents like GLP-1 receptor agonists for cardiometabolic disease, hold promise for reducing mortality. However, the study underscores that technological solutions alone are insufficient without addressing structural and social dimensions of health. Embracing comprehensive public health reforms that encompass socioeconomic policy, healthcare delivery, and community support are essential for meaningful and sustainable reductions in excess death rates.

In conclusion, the Boston University study offers a clarion call to action: the burgeoning U.S. mortality disadvantage stems from a confluence of cardiovascular, metabolic, neurological, behavioral, and social determinants. Tackling this complex challenge requires an integrative approach that transcends simplistic clinical interventions, prioritizing systemic policy change and social determinants to mitigate the “missing Americans” phenomenon. The findings not only quantify the urgent mortality crisis but also chart a path forward toward improving health equity and longevity across the nation.

Subject of Research: People

Article Title: Causes of Excess Deaths in the US Compared with Other High-Income Countries

News Publication Date: 8-May-2026

Web References:

• https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2026.6147?guestAccessKey=1b34668e-afe8-4888-aa3d-dd05b3b83eff&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=050826

References:

• Boston University study in JAMA Network Open, DOI: 10.1001/jamanetworkopen.2026.6147

Keywords: mortality rates, cardiovascular disease, cardiometabolic diseases, excess deaths, drug poisoning, public health, COVID-19, Alzheimer’s disease, dementia, substance abuse, social determinants of health, health disparities

Medicaid, the nation’s major source of health coverage for low-income Americans, has long been a critical safety net, providing access to essential medical services to millions whose financial circumstances preclude private insurance coverage. Despite bipartisan recognition of Medicaid’s role, recent legislative proposals suggest drastic budget realignments that would fundamentally alter the landscape of care. Dr. Gaffney’s team modeled six primary Medicaid cuts projected to individually save at least $100 billion over a decade: lowering the Medicaid matching minimum, curtailing funding for ACA expansions, instituting per capita spending caps, imposing work requirements for eligibility, slashing provider taxes, and rescinding Biden-era expansions of eligibility guidelines.

The analytical framework employed integrates data on Medicaid enrollment trends, healthcare utilization rates, and mortality outcomes, drawing from national health databases and prior empirical studies. Utilizing these inputs, the model forecasts the wide-reaching consequences on uninsurance rates, access to medical care, and clinical outcomes should these budget reductions be realized. Notably, each singular cut is projected to increase medically preventable deaths annually—ranging from over 650 to more than 12,600—highlighting the lethal public health risks posed by disentangling vulnerable populations from Medicaid services.

Beyond mortality, the study underscores that the policy shifts would dramatically swell the ranks of uninsured Americans by hundreds of thousands to several million, imperiling continuity of care and worsening chronic disease management. Patients are predicted to forgo vital healthcare services in numbers approaching nearly a million annually, reflecting the barriers that cost increases and reduced coverage impose. The modeling projects that the specific package of cuts included in the current House reconciliation bill, in particular, would propel the number of uninsured people upward by an astonishing 7.6 million.

Furthermore, the ramifications extend to disruptions in patient-provider relationships, a cornerstone of effective care. The analysis estimates that nearly two million individuals could lose access to their personal physicians. Additionally, the foregone medical necessities include missed medication refills by over a million people and, alarmingly, hundreds of thousands of women foregoing recommended mammography screenings annually. Collectively, these gaps in preventive and ongoing care foreshadow escalating morbidity and long-term declines in population health.

The researchers emphasize that these budgetary measures, while intended to offset tax cuts largely benefiting high-income individuals and corporations, portend a stark trade-off—sacrificing the health and wellbeing of vulnerable Americans for fiscal austerity. This trade-off is underscored by the projected toll of more than 16,500 preventable deaths per year, a figure representing an extraordinary human cost that reverberates far beyond economic calculations. The findings challenge policymakers to reckon with the ethical and clinical consequences of Medicaid retrenchment and to consider alternative fiscal strategies that do not imperil the lives of the economically disadvantaged.

Dr. Gaffney and colleagues further advocate for a holistic appraisal of Medicaid cuts in the context of broader socio-economic inequities that already impose health disparities on low-income communities. The research suggests that these legislative proposals would deepen systemic inequities by stripping health coverage from precisely those groups most in need—amplifying existing barriers to timely medical intervention and continuity of care. The study calls for reinforced safeguards ensuring that budgetary reforms do not exacerbate well-documented social determinants of poor health.

The technical rigor of the study is bolstered by its integration of multiple data sources, robust sensitivity analyses, and the modeling of differential effects across demographic strata. The authors present a transparent methodology that enables replication and informs evidence-based policy discussions. Statistical projections regarding mortality and morbidity are coupled with economic estimations, producing a multidimensional assessment crucial for legislators grappling with the multifaceted impacts of healthcare financing decisions.

As the legislative timeline accelerates, this research provides a data-driven lens through which the potential human and healthcare system costs can be scrutinized. The study’s projections serve as a clarion call to the medical community, health economists, and policymaking bodies, emphasizing that retrenchment in Medicaid funding is not merely a fiscal abstraction but a tangible determinant of life and death. It underscores the continued necessity of Medicaid as a linchpin in the U.S healthcare safety net, particularly as medical inflation and social needs intensify.

Beyond the immediate health consequences, the study touches upon the downstream economic effects, including increased uncompensated care burdens on healthcare providers and potential destabilization of health systems serving low-income populations. The disruption of coverage continuity could fuel cost-shifting to emergency departments and increase the reliance on high-cost, late-stage interventions, thereby negating theoretical near-term fiscal savings and imposing greater long-term economic strain on state and federal budgets.

The findings invite a broader societal reflection on the value placed on equitable healthcare access and social solidarity in health policy. The projected health crises underscore the complex interplay between policy decisions, healthcare infrastructure, and population outcomes. The authors stress that future policy deliberations must adopt an integrative approach weighing economic imperatives against population health imperatives, with particular sensitivity toward historically marginalized demographic groups.

Ultimately, this study portrays Medicaid not simply as a budget item subject to fiscal trimming but as a fundamental determinant of health equity and survival for millions of Americans. The compelling evidence presented advocates for preserving and strengthening Medicaid provisions, fostering a healthcare landscape where access is sustained rather than eroded. Policymakers, clinicians, and public health advocates alike are urged to carefully consider these projections when shaping the trajectory of federal healthcare investments in the decade ahead.

Subject of Research: People

Article Title: Projected Effects of Proposed Cuts in Federal Medicaid Expenditures on Medicaid Enrollment, Uninsurance, Healthcare and Health

News Publication Date: 17-Jun-2025

Web References: http://dx.doi.org/10.7326/ANNALS-25-00716

Keywords: Health insurance, Health care policy, Health care

This analytical tour de force traces mortality trends from 1980 through 2023, employing meticulous age-standardization techniques to adjust for demographic differences and juxtaposing U.S. death rates against an average derived from 21 peer countries including Australia, Canada, France, Japan, and the United Kingdom. The findings emphasize that while the COVID-19 pandemic exacerbated existing mortality discrepancies, the roots of this public health crisis extend well before the viral onslaught, reflecting systemic and structural failures in healthcare access, social policy, and prevention strategies.

Excess deaths, defined as the number of deaths above what would be expected if U.S. mortality mirrored peer countries, peaked at nearly 1.1 million in 2021 during the height of the pandemic. However, the subsequent reduction to approximately 820,000 in 2022 and 705,000 in 2023 did not signify a true recovery but rather a reversion to a concerning upward trajectory that predates COVID-19. Crucially, the 2023 tally remains significantly higher than the pre-pandemic figure of 631,000 in 2019, illustrating that the pandemic’s shadow looms larger and longer than anticipated.

The disproportionate impact on working-age adults is particularly harrowing. Nearly half – 46% – of all deaths among Americans under 65 could potentially have been averted if U.S. age-specific mortality rates conformed to those of other wealthy nations. This persistent age-related vulnerability underscores a critical public health dilemma, highlighting how crises such as drug overdoses, gun violence, and cardiometabolic diseases systematically erode vitality within a segment of the population traditionally considered to be in their productive prime. The continuity of these disparities before, during, and after the pandemic signals deeply ingrained social determinants and health system inadequacies that disproportionately affect younger Americans.

The study’s lead author, Dr. Jacob Bor, an epidemiologist and associate professor at BUSPH, describes this phenomenon as a “protracted health crisis,” one that has quietly unfolded beyond public gaze while claiming millions of avoidable lives. The metaphor of “missing Americans” poignantly encapsulates the magnitude of this issue, reflecting a failure at the population level that transcends individual behavior and signals profound policy neglect.

By examining mortality data exceeding 107 million U.S. deaths and more than 230 million deaths from peer countries, the research team applied rigorous counterfactual modeling to estimate excess mortality. This approach accounted for varying age distributions and leveraged standardized mortality ratios, ensuring robust, comparable metrics. Their data shows that between 1980 and 2023, the U.S. endured approximately 14.7 million excess deaths relative to its peers — a staggering figure that points to persistent and systemic health disadvantages.

Importantly, the study highlights that COVID-19 acted as an accelerant rather than an originator of mortality disparities. The virus precipitated a sharp increase in excess deaths in 2020 and 2021 but did so against a backdrop of existing vulnerabilities, including overdose epidemics driven by narcotics and opioids, escalating gun violence, fatal car crashes, and preventable cardiometabolic conditions such as heart disease and diabetes. These chronic challenges underscore the complex etiology of ongoing excess mortality, implicating societal, policy, and healthcare system failures.

Senior author Dr. Andrew Stokes of BUSPH points to the broader structural weaknesses exposed by the pandemic. In many high-income countries, robust universal health coverage, comprehensive social safety nets, and coordinated public health initiatives mitigated the pandemic’s toll. In contrast, the U.S.’s fragmented healthcare system, marked by inequities in access and quality, alongside social determinants such as economic instability and political polarization, have stymied effective responses both to COVID-19 and to foundational causes of premature death.

The social and political landscape further complicates U.S. efforts to bridge the mortality gap. Public distrust of government institutions and increasing political divisiveness undermine consensus on implementing evidence-based health policies. These barriers hinder the adoption of proven practices seen in peer countries, such as harm reduction approaches for substance abuse, stricter gun regulation, and expanded preventive care.

Researchers emphasize the urgency of reversing these trends through informed policy interventions. Lessons from international counterparts suggest that investment in universal healthcare systems, strengthened social safety mechanisms, and comprehensive environmental and regulatory frameworks can promote healthier, longer lives and reduce preventable deaths. The failure to leverage these insights, coupled with austerity measures targeting health and social programs, threatens to widen disparities further.

Additionally, the research team warns that recent governmental policies, including cuts to public health funding, reductions in scientific research investment, and diminished data transparency, could exacerbate the mortality disadvantage. These policies risk perpetuating the cycle of preventable deaths by weakening the infrastructure necessary to identify, monitor, and address health crises effectively.

The study also aligns with a parallel investigation published earlier in 2025 revealing that drug-related deaths now constitute the leading cause of mortality among adults aged 25 to 44. This grim statistic emphasizes the entrenched nature of the overdose epidemic and the critical need for multisectoral public health interventions targeting addiction and mental health.

Moving forward, the researchers advocate for comprehensive, multi-level policy strategies that espouse equity, evidence, and prevention. Future investigations will seek to disentangle the specific causes driving these mortality differences, integrating epidemiological, sociological, and policy perspectives to chart actionable paths toward closing the mortality gap.

In closing, this sobering analysis reinforces that the U.S. faces a formidable public health challenge whose magnitude rivals historic crises. Addressing this simmering mortality epidemic requires concerted efforts to overhaul healthcare infrastructure, revive social safety nets, and embrace pragmatic, evidence-informed policies that prioritize population health. Without such transformation, the narrative of “missing Americans” will continue, chronicling the preventable loss of millions of lives and a national failure to safeguard the health of its people.

Subject of Research: People

Article Title: Excess Deaths Before, During, and After the COVID-19 Pandemic

News Publication Date: 23-May-2025

Web References:
https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2025.1118?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=052325

References:
Bor J, et al. Excess Deaths Before, During, and After the COVID-19 Pandemic. JAMA Health Forum. 2025; DOI: 10.1001/jamahealthforum.2025.1118.

Image Credits: Boston University School of Public Health

Keywords: Mortality rates, Viral infections, Public health, Epidemics, Substance abuse, Drug abuse, Violence, Gun violence, Cardiovascular disorders, Cardiovascular disease, Heart failure, Heart disease, Health care, Adults, Young people, Narcotics addiction, Opioid addiction, COVID 19, Long Covid