Americans are dying younger than peers abroad. Researchers point to why - Newsweek

Americans are dying at higher rates than people in other wealthy nations not only because of drug overdoses, suicides and homicides but increasingly because of a broad range of chronic diseases, according to a new study that found the U.S. mortality crisis extends far beyond the commonly cited "deaths of despair."

The study's corresponding author, Dr. Steven Woolf from Virginia Commonwealth University's School of Medicine, found that rising death rates from conditions such as hypertensive disease, endocrine and metabolic disorders, alcoholic liver disease, neurologic diseases, and genitourinary diseases have contributed to a widening life expectancy gap between the U.S. and other "high-income countries."

Experts told Newsweek that problems with health care access, affordability and prevention may be driving the trend.

The findings concluded that U.S. life expectancy ranked 38th among countries with populations exceeding 1 million in 2023, while residents of 60 countries faced a lower risk of dying before age 40 than Americans. Newsweek has contacted the study's representative for more information.

The study examined mortality data from 1999 to 2023 in the U.S. and compared it with 16 other high-income countries. Researchers drew on data from the United Nations, the U.S. Mortality Database, the Centers for Disease Control and Prevention, and the Organization for Economic Co-operation and Development.

While external causes of death—especially drug overdoses, suicides and homicides—remain major contributors to excess mortality, researchers found that they do not fully explain the U.S. health disadvantage.

Among young adults aged 25 to 44, all-cause mortality increased by 71.2 percent between 2010 and 2021. In addition to overdoses and other external causes, deaths from early-onset diseases including hypertensive disease, endocrine and metabolic disorders, and alcoholic liver disease rose sharply.

Middle-aged adults experienced increased mortality from many of the same conditions, alongside higher death rates from nervous system and genitourinary diseases.

Older adults also saw growing mortality from neurologic diseases and endocrine and metabolic disorders.

Since 2010, the mortality gap between the U.S. and comparable countries has increasingly been driven by circulatory diseases, respiratory illnesses, nervous system diseases, endocrine and metabolic disorders, and external causes, the study said.

COVID-19 also worsened the trend, becoming a leading cause of death among middle-aged and older adults. However, the researchers noted that non-COVID causes continued to claim lives even as the pandemic subsided.

Mónika López Anuarbe, a professor of economics at Connecticut College and health economist affiliated with the college's Public Health Pathway, said the findings highlight long-standing shortcomings in the U.S. health system.

"When trying to understand why the U.S. is where it is in terms of mortality rates, the iron triangle of health care comes to mind: access to care, cost containment and quality of care," she told Newsweek.

López Anuarbe said rising costs increasingly affect insured and middle-class Americans, causing some to delay or forgo treatment.

"When people forgo care because of cost, the probability of addressing a health condition in time decreases, which can lead to higher mortality rates," she said. "Affordability has become a barrier even for insured Americans."

"If people delay or avoid care because they cannot afford it, conditions that could have been identified or treated earlier can become much more serious," López Anuarbe continued.

She pointed to striking differences within states. In Connecticut, she said, there is nearly a 30-year gap in life expectancy between residents of East Hartford and Westport.

Jagdish Khubchandani, a professor of public health at New Mexico State University, said the study raises difficult questions about why the country spends more on health care than any other nation while continuing to lag behind many peers.

"A high-level observation is that while comparing to somewhat similar and developed countries, we have higher mortality, and this mortality gap is largely driven by heart diseases, respiratory illness, metabolic health issues, and many external causes," he told Newsweek. "Many such deaths are preventable."

Khubchandani said the sharp rise in deaths among working-age adults is linked to drug overdoses, suicides, homicides, alcohol-related liver disease and heart disease associated with high blood pressure. He argued that prevention measures, such as improving access to naloxone and addressing harmful health behaviors, could help reduce mortality.

"But unfortunately, we have a lot of hurdles for all these preventive measures," he said, adding, "The other problem is that the aforementioned preventable causes of premature mortality are rooted in or overlap with many other systemic issues, from a fragmented health care system to food that is obesogenic and ultra-processed, and social safety nets that are being curtailed or debated."

"So increasing access to treatments for heart disease, for example, may not be an effective and sustainable solution," Khubchandani added.

The study proposes that closing the gap with other high-income countries will require addressing broader factors that affect health, including access to health care, socioeconomic conditions, environmental risks and long-standing health inequalities.

Woolf, S. H. (2026). US Life Expectancy and Increasing Mortality Rates: An Analysis of the Crisis. The Milbank Quarterly. https://doi.org/10.1111/1468-0009.70118.

Contact Newsweek editors on this story: Kara Dolman and Shakeema Edwards.