Avoidable deaths are on the rise in the United States, yet falling in many peer nations

When a person dies, clinicians often look at the cause of death to determine whether it could have been avoided, either by medical prevention such as vaccines or by treatments like antibiotics. These types of deaths are known as avoidable mortalities, and in most high-income countries around the world, the number is going down.

But in the United States, avoidable deaths have been on the rise for more than a decade, according to a new study by researchers at the Brown University School of Public Health and Harvard University, who examined mortality trends across U.S. states and 40 high-income countries. Their findings were published in JAMA Internal Medicine.

The team compared mortality data from all 50 U.S. states with data from countries in the European Union and the Organization for Economic Cooperation and Development, whose 38 members include Australia, Japan and Iceland. They found that between 2009 to 2021, avoidable mortality in the U.S. kept getting worse, while avoidable mortality in the EU and OECD improved (with the exception of the period of time during COVID-19 pandemic from 2019 to 2021).

The findings suggest that deep-seated issues in the American health care system and public policy may be contributing to worsening health outcomes, said lead study author Irene Papanicolas, a professor of health services, policy and practice at Brown’s School of Public Health.

“We’ve known for some time that life expectancy has been getting worse in the U.S., but now we can see that the country is on a different trajectory from other high-income countries,” said Papanicolas, who is also the director of the Center for Health System Sustainability. “Other countries are getting better at reducing avoidable deaths through prevention and treatment, but in the U.S., these deaths are growing.”

The researchers compared mortality data from individual U.S. states to data from high-income countries of similar scale, and also used aggregate data to compare the U.S. overall to the aggregates of other countries.

On average, avoidable mortality increased across the U.S. by 32.5 avoidable deaths per 100,000 people. By contrast, avoidable mortality decreased in EU countries by 25.2 avoidable deaths per 100,000 people and decreased in OECD countries by 22.8 avoidable deaths per 100,000 people.

“It’s a bit shocking,” Papanicolas said. “What we found is that while avoidable mortality varies by state, all U.S. states are getting worse.”

In New York, for instance, avoidable mortality from 2009 to 2019 increased by 4.9 deaths per 100,000 people; in West Virginia, avoidable mortality increased by 99.6 deaths per 100,000 people.

When the researchers examined the causes of avoidable deaths (including road traffic accidents, illnesses preventable by vaccines, treatable conditions like sepsis or appendicitis, and conditions preventable by early detection and treatment like cervical cancer, ischemic heart disease and tuberculosis), they found that deaths from a variety of different causes are rising in every U.S. state.

“There’s been a lot of discussion about preventable deaths in the U.S. such as drug-related deaths or suicides, which do account for a big proportion of this trend,” Papanicolas said. “However, we found that deaths from nearly all major categories are increasing.”

An exception, she noted, is that death rates from cancer are decreasing in some U.S. states.

The team found no clear association between health expenditures and avoidable mortality in the U.S., meaning that states that spend more on health care don’t necessarily fare better. On the other hand, in the high-income countries evaluated in the study—including Canada, Japan, Spain and Turkey—there was a correlation between higher spending on health care and better outcomes in terms of avoidable mortality.

These findings are particularly concerning, Papanicolas said, because the U.S. spends more on health care per capita than any other country in the analysis.

“The results point to systemic factors that the U.S. and all its states are dealing with,” she said.

The analysis involved mortality data for people under the age of 75 from the Centers for Disease Control and Prevention and from the World Health Organization. Health spending data came from the U.S. Census Bureau, the Centers for Medicare and Medicaid Services, the Office of the Actuary and from the WHO Global Health Expenditure Database.

This study, which builds on previous research by this team, serves as a call to action for U.S. policymakers to address this growing mortality gap, Papanicolas said.

Moving forward, she said, the researchers plan to investigate what the U.S. can do better.

“It’s really interesting to see how the U.S. is different, but where we want to explore next is what other countries are doing that the U.S. can do to bring down avoidable deaths,” she said.

When a person dies, clinicians often look at the cause of death to determine whether it could have been avoided, either by medical prevention such as vaccines or by treatments like antibiotics. These types of deaths are known as avoidable mortalities, and in most high-income countries around the world, the number is going down.

But in the United States, avoidable deaths have been on the rise for more than a decade, according to a new study by researchers at the Brown University School of Public Health and Harvard University, who examined mortality trends across U.S. states and 40 high-income countries. Their findings were published in JAMA Internal Medicine.

The team compared mortality data from all 50 U.S. states with data from countries in the European Union and the Organization for Economic Cooperation and Development, whose 38 members include Australia, Japan and Iceland. They found that between 2009 to 2021, avoidable mortality in the U.S. kept getting worse, while avoidable mortality in the EU and OECD improved (with the exception of the period of time during COVID-19 pandemic from 2019 to 2021).

The findings suggest that deep-seated issues in the American health care system and public policy may be contributing to worsening health outcomes, said lead study author Irene Papanicolas, a professor of health services, policy and practice at Brown’s School of Public Health.

“We’ve known for some time that life expectancy has been getting worse in the U.S., but now we can see that the country is on a different trajectory from other high-income countries,” said Papanicolas, who is also the director of the Center for Health System Sustainability. “Other countries are getting better at reducing avoidable deaths through prevention and treatment, but in the U.S., these deaths are growing.”

The researchers compared mortality data from individual U.S. states to data from high-income countries of similar scale, and also used aggregate data to compare the U.S. overall to the aggregates of other countries.

On average, avoidable mortality increased across the U.S. by 32.5 avoidable deaths per 100,000 people. By contrast, avoidable mortality decreased in EU countries by 25.2 avoidable deaths per 100,000 people and decreased in OECD countries by 22.8 avoidable deaths per 100,000 people.

“It’s a bit shocking,” Papanicolas said. “What we found is that while avoidable mortality varies by state, all U.S. states are getting worse.”

In New York, for instance, avoidable mortality from 2009 to 2019 increased by 4.9 deaths per 100,000 people; in West Virginia, avoidable mortality increased by 99.6 deaths per 100,000 people.

When the researchers examined the causes of avoidable deaths (including road traffic accidents, illnesses preventable by vaccines, treatable conditions like sepsis or appendicitis, and conditions preventable by early detection and treatment like cervical cancer, ischemic heart disease and tuberculosis), they found that deaths from a variety of different causes are rising in every U.S. state.

“There’s been a lot of discussion about preventable deaths in the U.S. such as drug-related deaths or suicides, which do account for a big proportion of this trend,” Papanicolas said. “However, we found that deaths from nearly all major categories are increasing.”

An exception, she noted, is that death rates from cancer are decreasing in some U.S. states.

The team found no clear association between health expenditures and avoidable mortality in the U.S., meaning that states that spend more on health care don’t necessarily fare better. On the other hand, in the high-income countries evaluated in the study—including Canada, Japan, Spain and Turkey—there was a correlation between higher spending on health care and better outcomes in terms of avoidable mortality.

These findings are particularly concerning, Papanicolas said, because the U.S. spends more on health care per capita than any other country in the analysis.

“The results point to systemic factors that the U.S. and all its states are dealing with,” she said.

The analysis involved mortality data for people under the age of 75 from the Centers for Disease Control and Prevention and from the World Health Organization. Health spending data came from the U.S. Census Bureau, the Centers for Medicare and Medicaid Services, the Office of the Actuary and from the WHO Global Health Expenditure Database.

This study, which builds on previous research by this team, serves as a call to action for U.S. policymakers to address this growing mortality gap, Papanicolas said.

Moving forward, she said, the researchers plan to investigate what the U.S. can do better.

“It’s really interesting to see how the U.S. is different, but where we want to explore next is what other countries are doing that the U.S. can do to bring down avoidable deaths,” she said.