A 30-year-old American is three times more likely to die at that age than his or her European peers. In fact, Americans do worse at just about every age. To make matters more grim, the American disadvantage is growing over time.
In 2017, for example, higher American mortality translated into roughly 401,000 excess deaths – deaths that would not have occurred if the US had Europe’s lower age-specific death rates. Pre-pandemic, that 401,000 is about 12% of all American deaths. The percentage is even higher below age 85, where one in four Americans die simply because they do not live in Europe.
There have been many efforts to account for the US mortality disadvantage. There is no single answer, but three factors stand out. First, death rates from drug overdose are much higher in the US than in Europe and have risen sharply in the 21st century. Second is the rapid rise in the proportion of American adults who are obese. In 2016, 40% of American adults were obese, a larger proportion than in Europe. Higher levels of obesity in the US may account for 55% of its shortfall in life expectancy relative to other rich countries. Third, the US stands out among wealthy countries for not offering universal healthcare insurance. One analysis suggests that the absence of universal healthcare resulted in 45,000 excess deaths at ages 18-64 in 2005. That number represents about a quarter of excess deaths in that age range.
Above age 65, healthcare insurance coverage is nearly universal via Medicare. An international review of medical practice by the National Academy of Sciences suggested that the US does comparatively well in identifying and treating cardiovascular diseases and many cancers. But the prevalence of these diseases, the principal killers in wealthy countries, is unusually high in the US. Heart disease, a type of cardiovascular disease and America’s number one cause of death for decades, is strongly linked to lifestyle factors such as obesity. Although the connection between obesity and health risks is well known, consumer preferences for unhealthy food are strong. Not just because humans are biologically vulnerable to sweets and fats, but because major food producers and distributors are incentivized to turn this weakness into profit.
LAST YEAR was a woeful time for people suffering from a drug addiction. Government shutdowns brought job losses and social isolation—conditions that make a transportive high all the more enticing. Those who had previously used drugs with others did so alone; if they overdosed, no one was around to call for help or administer naloxone, a medication that reverses opioid overdoses.
Fatal overdoses were marching upwards before the pandemic. But they leapt in the first part of last year as states locked down, according to provisional data from the Centres for Disease Control and Prevention. Deaths from synthetic opioids—the biggest killer—were up by 52% year-on-year in the 12 months to August, the last month for which data are available. Those drugs killed nearly 52,000 Americans during the period; cocaine and heroin killed about 16,000 and 14,000, respectively (see chart). Once fatalities are fully tallied for 2020, in a few months’ time, it is likely to be the deadliest year yet in America’s opioid epidemic.
The CDC’s National Vital Statistics System (NVSS) provides monthly provisional data on predicted total drug overdose deaths during the preceding 12 months. The most recent data reflect September 2019 through August 2020. During that period, there were 88,295 predicted deaths, a record high that is almost 19,000 more deaths (27%) than the prior 12-month period.
Using these predicted data in combination with final data from 2019, we estimated monthly overdose deaths from January to August 2020. Our estimates show that total overdose deaths spiked to record levels in March 2020 after the pandemic hit. Monthly deaths grew by about 50 percent between February and May to more than 9,000; they were likely still around 8,000 in August. Prior to 2020, U.S. monthly overdose deaths had never risen above 6,300.