According to a study led by a researcher from the Boston University School of Public Health (BUSPH), the United States could have prevented 1.1 million deaths in 2021 if it had mortality rates similar to other wealthy nations. The study, published in the journal PN__AS Nexus, refers to these deaths as “Missing Americans,” since they represent people who would still be alive if the US mortality rates were the same as those of its peer countries.
The authors compared the death rates of the US and 21 other wealthy nations from 1933 to 2021, finding that the current death rates in the US are significantly higher than those of other wealthy nations, and that the number of excess US deaths has never been higher. Almost half of all “Missing Americans” died before the age of 65 in 2020 and 2021.
The COVID-19 pandemic contributed to a sharp increase in mortality in the US, more so than in other countries. However, the new findings show that the number of excess US deaths has been increasing rapidly over the last four decades. Dr. Bor and colleagues analyzed trends in US deaths from 1933 to 2021, including the impact of COVID-19, and then compared these trends with age-specific mortality rates in Canada, Japan, Australia, and 18 European nations.
During World War II and its aftermath, the US had lower mortality rates than similar countries. From the 1960s to the 1970s, the US had mortality rates that were similar to other wealthy nations. Starting in the 1980s, the number of Missing Americans began to increase annually, reaching 622,534 excess US deaths in 2019. Deaths spiked to 1,009,467 in 2020 and 1,090,103 in 2021 during the pandemic. From 1980 to 2021, there were a total of 13.1 million Missing Americans.
The researchers emphasize that this mortality crisis affects all races and ethnicities. Black and Native Americans are overrepresented in these measures, with mortality rates in early adulthood (ages 15-44) that were five and eight times higher than the average of other wealthy nations. The team also explains that structural racism in the US, including policies such as slavery and redlining, has contributed to racial and ethnic disparities in wealth and in access to education, housing, and healthcare that drive leading causes of worse mortality rates, particularly at young ages.
Two-thirds of the Missing Americans are White, a result of the larger population of White Americans, their older age distribution, and death rates that are significantly higher than other wealthy nations.
In 2021, excess U.S. mortality resulted in 26.4 million years of life lost when accounting for future years of life that were cut short. This number is higher than that of other nations. The team attributes this to the US policy’s failure to address major public health issues, such as the opioid epidemic, gun violence, environmental pollution, economic inequality, food insecurity, and workplace safety. The COVID-19 pandemic worsened many of these issues, especially among vulnerable groups. Even though most of the safety-net policies put in place during COVID-19 have expired, these groups still need vital support. Compared to the US, other countries had higher vaccination uptake and stricter mask policies during the Omicron wave, which led to fewer COVID-19 cases.
