Study details and findings

For the study, researchers analyzed all-cause mortality data from the Human Mortality Database for the United States and 21 other high-income countries (HICs) from January 1980 to December 2023.

The researchers calculated age-specific mortality rates for the United States and the population-weighted average for other HICs. Then, they calculated the number of U.S. deaths that could have been expected to occur if the United States had experienced the age-specific mortality rates in other HICs and subtracted that from the number of observed U.S. deaths to determine the number of excess deaths.

Overall, there were 107.5 million deaths in the United States and 230.2 million deaths in other HICs between 1980 and 2023. During this time, the researchers estimated that 14.7 million excess deaths occurred in the United States compared with other HICs.

The number of excess U.S. deaths peaked in 2021 during the pandemic, with almost 1.1 million excess deaths. However, even after the pandemic, excess U.S. deaths remained high, with over 800,000 in 2022 and around 700,000 in 2023. In comparison, the number of excess deaths in 2019 was a little over 630,000. 

"Mortality rates decreased more slowly in the US than in other high-income countries (HICs) between 1980 and 2019, resulting in growing numbers of excess US deaths compared with other HICs," the researchers wrote.

"These deaths reflect not individual choices, but policy neglect and deep-rooted social and health system failures," said Andrew Stokes, an associate professor of global health and epidemiology at BUSPH and the study's senior author. "The COVID-19 pandemic exposed structural weaknesses—including gaps in healthcare access and social supports—that have continued to fuel premature deaths even after the acute phase of the pandemic ended."

More research is needed to determine the specific causes of the disparity between the mortality rates of the United States and other HICs. To help reduce excess mortality rates, the researchers said the United States should look at health policies from peer countries for recommendations.

"Other countries show that investing in universal healthcare, strong safety nets, and evidence-based public health policies leads to longer, healthier lives," Stokes said. "Unfortunately, the U.S. faces unique challenges; public distrust of government and growing political polarization have made it harder to implement policies that have proven successful elsewhere."

Recent executive actions and policy changes from the Trump administration may also negatively impact efforts to reduce excess deaths in the United States. For example, the U.S. House of Representatives recently passed a budget bill that proposes cuts to Medicare, Medicaid, and the Affordable Care Act.

"Deep cuts to public health, scientific research, safety net programs, environmental regulations, and federal health data could lead to a further widening of health disparities between the U.S. and other wealthy nations, and growing numbers of excess — and utterly preventable — deaths to Americans," Bor said.