America's oversized death rate

Our mortality rates from non-Covid causes have been rising for years. Among 18 high-income countries, America’s life expectancy ranks dead last. A million more Americans died each year than would have if our overall mortality matched those of peer countries in Europe.

• In a quarter of American counties, death rates among working-age adults are higher than they were 40 years ago.
• Homicide rates involving a firearm are 22 times higher here than in the European Union.
• The death rate among children grew more than 15 percent between 2019 and 2021, with little of that attributable to Covid.
• For the first time in half a century, all-cause mortality in children ages 1-19 years began to increase, due primarily to homicide, suicide, vehicle injuries, and drug overdoses.
• Our maternal mortality rate is more than three times as high as that of other wealthy countries, and our newborns have the highest infant mortality rate in the rich world.
• Life expectancy among America’s poorest men may be 20 years shorter than their counterparts in the Netherlands and Sweden.

Whatever accounts for this decrease in life expectancy appears to be uniquely American. Something systemic to the U.S. is limiting survival. “Deaths of despair,” such as opioid overdoses, alcoholic liver disease, and suicides, account for some of the increased death rates. But mortality from other causes has also increased, including Alzheimer’s, diabetes, kidney failure, heart failure, vehicle collisions, and firearms. In addition to deaths of despair, experts posit a number of other possible causes for our decrease in life expectancy, including obesity, limited access to health care, health care affordability, loss of social support systems, chronic stress, and an increase in high school dropouts.

On the other hand, it looks like we do pretty well at keeping old people alive: the chances that an American 75-year-old makes it to 90 or 100 are about the same as in other wealthy countries. In the U.S., the trick is to make it to 60.

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