The study, published in JAMA Network Open by researchers at Boston University School of Public Health, analyzed mortality data from the U.S. and 17 other high-income countries including Canada, France, Japan and the United Kingdom.
Overall U.S. mortality in 2022 was 38% higher than in comparable countries, the researchers found. Cardiovascular conditions — including ischemic heart disease, hypertension and stroke — were the leading driver. After declining for years, death rates from those conditions began rising again after 2010. Combined with metabolic diseases such as diabetes and kidney disease, as well as dementia including Alzheimer's, cardiovascular and metabolic causes accounted for more than half of all U.S. excess deaths in 2022.
The study also documented a sharp rise in deaths linked to substance use — primarily drug overdoses, alcohol-related illness and suicide — particularly after 2013, when fentanyl became widespread in the U.S. drug supply. Drug poisoning deaths exceeded 130,000 in 2022, a figure researchers said dwarfs rates seen in other wealthy nations.
Among Americans over 85, Alzheimer's and other dementias ranked among the top causes of excess mortality. The U.S. also showed higher-than-peer death rates from HIV/AIDS, homicide, respiratory disease and traffic accidents. COVID-19 widened the gap further, accounting for roughly one-fifth of excess deaths between 2020 and 2022.
The authors stressed that the problem extends beyond healthcare quality. Poverty, chronic stress, lifestyle factors and social inequality all play significant roles, they said.
"Countries with similar or even worse access to advanced medical technologies achieve far better health outcomes than the U.S.", said lead author Dr. Jacob Bor. "We need to ask what solutions those countries have implemented and whether they could be applied here".
The researchers called for further investigation into the post-2010 mortality surge, arguing that reversing the trend would require not only new treatments but also broader social and policy interventions.
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Source: PAP