Cardiometabolic diseases remain leading cause of excess American mortality

Between 1999 and 2022, the US had substantially higher death rates than other wealthy nations, largely due to cardiovascular disease, metabolic diseases (including diabetes), Alzheimer's disease and related dementias, and drug and alcohol complications. Policies are needed to address the underlying health, social, and economic conditions that increase Americans' risk of developing these diseases.

Despite having similar access to advanced medical technology, the United States has substantially higher death rates than other high-income countries (HICs), and the gap has been growing for decades. Cardiovascular diseases were the leading cause of excess US deaths, according to a new study led by researchers at Boston University School of Public Health (BUSPH).

Published in JAMA Network Open, the study found that between 1999-2022, the annual number of excess US deaths-deaths that would not have occurred had the mortality rate in the US been the same as in other HICs-increased steadily through 2019 and then rose rapidly during the COVID-19 pandemic. By 2022, all-cause mortality rates in the US were 38 percent higher than in other HICs. An estimated 12.7 million US deaths could have been averted during this period if US mortality rates mirrored those of its peers. The authors refer to these excess US deaths as "missing Americans."

The study investigated the causes of these excess US deaths, and found that cardiovascular diseases, including heart disease, hypertension, and stroke, were the leading cause of excess mortality nearly every year of this period. Together, cardiovascular and metabolic diseases accounted for over half of all excess US deaths in 2022. Drug poisonings, alcohol-related diseases, and suicides emerged as another major cause of excess mortality during this period, particularly among men and people under 45 years old. Homicide and HIV/AIDS also had mortality rates many times higher in the US than in other HICs; however, these causes were responsible for only a small share of excess US deaths.