News Release

Missing Americans


A new study assesses how many U.S. deaths would be avoided every year if the U.S.’s mortality rates were equal to other wealthy peer nations. Researchers looked at death rates from 21 other countries from 1933 to 2021. They found that starting in the late 1970s and early 1980s, age-specific mortality rates increased in the U.S. compared to those peer nations––ie. mortality rates are higher in the U.S. than the rates observed in other places. By the time the Covid-19 pandemic arrived, 600,000 more Americans were dying every year than we would expect if the U.S. had mortality rates equal to comparable countries. 

By 2021, fully “half of all deaths under 65 years…would have been avoided if the U.S. had the mortality rates of its peers.” In other words, for every two Americans you know who died before the age of 65, one of them would still be alive had they lived in countries like Australia, Canada, Germany, Japan or Portugal. 

    Bor is an assistant professor in the departments of global health and epidemiology at Boston University School of Public Health.

Bor told the Institute for Public Accuracy: “The state of health and policy [as described by a 2021 Lancet commission on public policy and health in the Trump era] is a product of the longer-running trends and the continuation of decades of disinvestment in population health and shifting policy that dates back to early ’80s… The number of missing Americans has increased year over year from the 1980s to the present. That was when we saw the U.S. diverge from other wealthy nations in terms of health outcomes. We wanted to quantify that divergence. What is the difference between what we observe and what we would observe if the U.S. were at the average? [Our data] is a counterfactual: it gives us a sense of just how much life is being lost. 

“Several news cycles have focused on the drops in [U.S.] life expectancy. [This data shows] what that actually means and how poorly we’re doing compared to other places. Life expectancy doesn’t apply to an individual; it applies to a population.”

Bor was especially struck by the fact that a disproportionate number of missing Americans die early in life. “It doesn’t have to be that way. We have Medicare and Social Security after age 65. We have reasonable programs for children. It’s working-age adults that we leave people to their own devices, force them to privately insure for medical care and bear all the risk themselves: housing, violence, foods, environmental exposures. If the U.S had mortality rates of other nations, fully half of all deaths before 65 would be averted.

“There has been literature on excess deaths in the pandemic. That literature compares 2020 and 2021 and 2022 mortality rates to prior mortality rates, or predicted mortality rates. That renders invisible the differences at baseline between countries. It’s not a coincidence that the U.S. had the highest mortality impact of Covid relative to other nations and the worst mortality rates pre-Covid. 

“There is also a large literature on health disparities between blacks and whites. White Americans are the reference category––but white Americans have done terribly in the last generation, population-wise. We’re comparing [black Americans] to a group that’s already not doing well compared to peer nations.

“The U.S. policy environment is the big story. [This data] shines a light on the ways all groups are suffering––before the pandemic and after––related to systemic gaps in the social safety net that are really quite different in the U.S. compared to other nations.”