Americans are dying younger than people in other wealthy countries, and this gap is widening. According to Gram Research analysis of mortality data from 1999 to 2023, the United States ranked 38th in life expectancy as of 2023, with 60 countries having lower death rates before age 40. Young adults aged 25 to 44 experienced a 71% increase in deaths between 2010 and 2021, driven primarily by drug overdoses, suicides, homicides, and early-onset diseases like high blood pressure and diabetes. Addressing this crisis requires not only treating individual diseases but also fixing systemic problems including healthcare access, poverty, and policies that fail to protect public health.
According to Gram Research analysis, the United States faces a serious health crisis: Americans are dying younger and at higher rates than people in other wealthy nations, and this gap is getting worse. A comprehensive review of mortality data from 1999 to 2023 found that drug overdoses, heart disease, suicide, and homicide are major killers, especially among young adults aged 25 to 44, whose death rates jumped 71% between 2010 and 2021. The research shows that fixing this problem requires more than just treating diseases, it means addressing deeper issues like poverty, poor access to healthcare, and policies that don’t protect public health.
Key Statistics
A 2026 review published in The Milbank Quarterly analyzing 25 years of mortality data found that the United States ranked 38th in life expectancy among countries with over 1 million people as of 2023, with 60 countries reporting lower death rates before age 40 than Americans.
Young adults aged 25 to 44 in the United States experienced a 71.2% increase in all-cause mortality between 2010 and 2021, driven primarily by drug overdoses, external causes, and early-onset diseases including high blood pressure and metabolic disorders, according to the 2026 Milbank Quarterly review.
A comprehensive 2026 analysis of mortality patterns across 16 high-income countries found that since 2010, the gap in all-cause mortality between the United States and comparable wealthy nations has been driven by higher American death rates from circulatory diseases, external causes, nervous system diseases, respiratory diseases, and metabolic disorders.
COVID-19 nearly doubled in mortality among middle-aged American adults in 2021 despite vaccine availability, emerging as the third leading cause of death in this age group according to the 2026 Milbank Quarterly review of US mortality data from 1999 to 2023.
The Quick Take
- What they studied: Why Americans die younger than people in other wealthy countries like Canada, Germany, and Japan, and what causes are driving this difference.
- Who participated: This was a review study that analyzed death records from the United States and 16 other high-income countries, examining data from 1999 through 2023 to compare mortality patterns and life expectancy.
- Key finding: As of 2023, Americans ranked 38th in life expectancy among countries with over 1 million people. Young adults aged 25 to 44 saw the biggest increase in deaths, jumping 71% between 2010 and 2021, mostly from drug overdoses and early-onset diseases like high blood pressure and liver disease from alcohol.
- What it means for you: This research suggests that Americans face serious health challenges that go beyond individual choices. Addressing this crisis requires changes to healthcare systems, policies that reduce poverty and inequality, and stronger regulation of harmful products like opioids and firearms. Individual actions matter, but systemic changes are essential for meaningful improvement.
The Research Details
Researchers conducted a comprehensive review of death records and health data from multiple sources, including the United Nations, the US Mortality Database, and the Centers for Disease Control and Prevention. They compared how many people die at different ages in the United States versus 16 other wealthy countries like Australia, Canada, France, Germany, Japan, and the United Kingdom. The analysis covered 25 years of data, from 1999 to 2023, allowing researchers to see trends over time and identify which causes of death have become more common. They also examined how life expectancy varies between US states and looked at whether state policies and political leadership affected health outcomes.
By comparing the United States to similar wealthy countries, researchers could identify which health problems are unique to America or worse here than elsewhere. This approach helps separate problems that affect all wealthy nations from problems specific to US policies and systems. Looking at data over 25 years shows whether problems are getting better or worse, and examining state-level differences reveals how local policies might influence health outcomes.
This review analyzed data from well-established, reliable sources like government health agencies and international organizations. The researchers examined multiple causes of death across different age groups and compared the United States to 16 other high-income countries, which strengthens the findings. However, this is a review study that synthesizes existing data rather than a new experiment, so it identifies patterns and correlations but cannot prove that specific policies directly cause health improvements. The findings reflect data through 2023, making this current and relevant to today’s health challenges.
What the Results Show
The United States has a serious life expectancy problem compared to other wealthy nations. As of 2023, Americans ranked 38th globally in life expectancy, meaning 60 countries have populations with lower risk of dying before age 40 than Americans do. This gap has widened over time, meaning the problem is getting worse, not better. The crisis affects different age groups in different ways. Young adults aged 25 to 44 experienced the largest relative increase in deaths of any age group, with a 71.2% jump between 2010 and 2021. For this age group, the main killers are external causes like drug overdoses, homicides, and suicides, along with early-onset diseases such as high blood pressure, diabetes, and liver disease from alcohol. Middle-aged adults face similar threats, plus increased deaths from nervous system diseases and kidney disease. Older adults experienced higher death rates from neurologic diseases, diabetes, and COVID-19. Since 2010, the gap between the United States and other wealthy countries has been driven by higher American death rates from heart and circulatory diseases, external causes like overdoses and violence, nervous system diseases, respiratory diseases, and metabolic disorders like diabetes.
COVID-19 emerged as a significant factor in the mortality crisis. Among middle-aged adults, COVID-19 became the third leading cause of death in 2020, and deaths nearly doubled in 2021 even though vaccines were available. This suggests that vaccine hesitancy and access issues contributed to preventable deaths. Infants and children face elevated risks from sudden unexplained infant deaths and external causes including accidents, homicide, and suicide. The research also found that state-level life expectancy and mortality rates appear connected to state policies and political orientation, suggesting that government decisions about healthcare, social services, and regulation affect population health outcomes.
This research builds on decades of observations that US health outcomes lag behind other wealthy nations. Previous studies identified specific problems like the opioid epidemic and high rates of gun violence, but this comprehensive review shows these are part of a larger pattern. The finding that young adults experienced a 71% increase in mortality between 2010 and 2021 represents a dramatic worsening of a trend that researchers have been tracking. The research confirms that the US health disadvantage is not due to a single cause but rather multiple interconnected factors ranging from individual behaviors to healthcare system failures to social and economic inequality.
This review synthesizes existing data rather than conducting new experiments, so it can identify patterns and correlations but cannot definitively prove that specific policies cause health improvements. The analysis relies on data from 16 high-income countries for comparison, which may not capture all relevant international examples. Some causes of death may be underreported or classified differently across countries, potentially affecting comparisons. The research cannot account for all possible explanations for differences between countries, such as genetic factors or unmeasured lifestyle differences. Additionally, while the analysis suggests connections between state policies and health outcomes, proving direct causation would require more detailed investigation.
The Bottom Line
Strong evidence supports implementing comprehensive policies to address the US mortality crisis. These include: expanding access to addiction treatment and mental health services to reduce drug overdose and suicide deaths; strengthening healthcare system capacity and affordability so more Americans can access preventive care; implementing evidence-based gun violence prevention measures; improving food environment regulations to reduce obesity and diet-related diseases; addressing poverty and economic inequality through social policies; and ensuring equitable access to healthcare across all communities. These recommendations have moderate to strong evidence from international comparisons showing that countries with such policies achieve better health outcomes. Individual actions like maintaining healthy weight, avoiding substance abuse, and seeking mental health support matter, but systemic changes are necessary for meaningful population-level improvement.
Everyone should care about this research because it affects public health policy that impacts all Americans. Policymakers and elected officials should prioritize these findings when making decisions about healthcare, social services, and regulation. Healthcare providers should be aware of these trends to better serve patients. Young adults aged 25 to 44 should pay particular attention since this age group experienced the largest increase in mortality. People struggling with addiction, mental health issues, or chronic diseases should seek available treatment and support. Communities with higher mortality rates should advocate for policies and resources to address local health challenges. People in states with strong health-focused policies can serve as examples for other regions.
Meaningful improvements in life expectancy typically take years to decades because they require systemic changes. Reducing drug overdose deaths might show improvements within 1 to 3 years if addiction treatment access expands significantly. Decreasing heart disease and diabetes deaths could take 5 to 10 years as people adopt healthier behaviors and receive better preventive care. Closing the gap with other wealthy countries would likely require 10 to 20 years of sustained policy commitment and implementation. Some improvements, like reducing gun violence deaths, could show results within 2 to 5 years if comprehensive prevention policies are enacted. The key is that progress requires consistent, long-term commitment to policy changes rather than short-term fixes.
Frequently Asked Questions
Why do Americans die younger than people in other rich countries?
Americans face higher death rates from drug overdoses, heart disease, suicide, homicide, and preventable diseases like diabetes. These problems stem from both individual risk factors and systemic issues including limited healthcare access, poverty, weak regulation of harmful products, and policies that don’t prioritize public health.
Which age group in America has the highest increase in death rates?
Young adults aged 25 to 44 experienced the largest increase in death rates, jumping 71% between 2010 and 2021. Drug overdoses, suicides, homicides, and early-onset diseases like high blood pressure and diabetes are the primary causes of death in this age group.
What can be done to improve American life expectancy?
Effective solutions include expanding addiction treatment and mental health services, improving healthcare access and affordability, implementing gun violence prevention measures, regulating the food environment to reduce obesity, addressing poverty and inequality, and ensuring equitable healthcare across all communities. These policy changes have proven effective in other wealthy countries.
How does COVID-19 factor into America’s mortality crisis?
COVID-19 became the third leading cause of death among middle-aged Americans in 2020 and nearly doubled in 2021 despite vaccine availability. This suggests vaccine hesitancy and access barriers contributed to preventable deaths, adding to the broader mortality crisis.
Can individual actions help address this mortality crisis?
Individual actions like maintaining healthy weight, avoiding substance abuse, seeking mental health support, and managing chronic diseases matter and can improve personal health. However, meaningful population-level improvement requires systemic changes to healthcare, social policies, and regulation that go beyond individual choices.
Want to Apply This Research?
- Track personal health metrics that address the leading causes of preventable death identified in this research: monitor daily steps or exercise minutes to reduce cardiovascular disease risk, log mood and stress levels to identify mental health concerns early, record alcohol consumption to prevent liver disease, and track medication adherence if taking treatments for high blood pressure or diabetes. Set weekly goals for each metric and review progress monthly.
- Use the app to identify which of the major risk factors identified in this research apply to you personally. If you struggle with substance use, set a goal to contact an addiction treatment service within one week and track your engagement with treatment. If you have untreated high blood pressure or diabetes, schedule a healthcare appointment and track follow-up visits. If you experience depression or suicidal thoughts, use the app to log these feelings and set reminders to contact a mental health professional or crisis line. Create a personalized action plan addressing your top 2 to 3 risk factors.
- Establish quarterly check-ins to review your health metrics and compare them to baseline measurements. Track whether you are meeting goals for exercise, mental health support, substance use recovery, or chronic disease management. If you have a chronic condition like high blood pressure or diabetes, monitor whether your condition is improving with treatment. Set reminders for annual health screenings and preventive care visits. Share your progress with a healthcare provider to ensure your tracking aligns with medical recommendations. Use the app to identify trends over time and adjust your health goals accordingly.
This research review examines population-level health trends and policy factors affecting mortality in the United States. It is not medical advice for individuals. If you are experiencing thoughts of suicide, struggling with substance use, or have concerns about your health, please contact a healthcare provider, mental health professional, or crisis service immediately. The findings presented reflect data analysis and comparisons between countries but cannot predict individual health outcomes. Always consult with qualified healthcare professionals about your personal health concerns, treatment options, and preventive care needs. State and local health resources vary, so check your area for available services and support programs.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.