Death Rates for Americans Ages 25-44 Jumped 71% in Just Over a Decade

Death rates for Americans between 25 and 44 years old jumped 71.2% in just eleven years, rising from about 140 deaths per 100,000 people in 2010 to 239 per 100,000 by 2021. No other age group came anywhere close to that surge. Overdoses, suicides, car crashes, and chronic diseases appearing at increasingly younger ages are now cutting down people in the prime of their lives.

Steven H. Woolf, a physician and researcher at Virginia Commonwealth University School of Medicine, published the analysis in The Milbank Quarterly. He combined data from the United Nations, the CDC, the Organisation for Economic Cooperation and Development, and a U.S. mortality database to show how far American life expectancy has fallen behind the rest of the developed world, and increasingly, much of the developing world too.

By 2023, U.S. life expectancy ranked 38th among countries with populations over 1 million, trailing not just Western Europe, Canada, Japan, and Australia but also Chile, Costa Rica, Slovenia, Israel, South Korea, and several Persian Gulf nations. Sixty countries had a lower risk of a person dying before age 40 than the United States did. That gap didn’t open overnight. It has been widening since the 1990s, and it sped up sharply after 2010.

How Researchers Tracked the Rising Death Rates

Woolf built this analysis by comparing decades of death records rather than running a new clinical trial or survey. He pulled data from the United Nations’ Department of Economic and Social Affairs, the U.S. Mortality Database, the CDC’s death-records database known as WONDER, and OECD data covering 16 other wealthy countries, including Canada, Japan, France, Germany, and the United Kingdom. He tracked age-specific death rates from 1999 through 2023, sorted into five groups: infants, youth ages 1 to 24, young adults 25 to 44, middle-aged adults 45 to 64, and adults 65 and older.

A separate part of the study looked at all 50 states from 1941 onward, matching each year of life expectancy data to the sitting governor’s political party to see whether state policy choices lined up with health outcomes over time.

What’s Driving the Rise in Death Rates Among Young Americans

Drug overdoses top the list. Among adults 25 to 44, the overdose death rate rose sevenfold after 1999, from about 7.7 per 100,000 to more than 54 per 100,000, and surpassed circulatory diseases (such as heart disease and stroke) in 2015 to become the leading cause of death in that age group. Suicide rates for this same group are higher than in any other age bracket and climbed more than 40% between 2000 and 2023. Homicides rose 75.5% between 2014 and 2021, and deaths from car crashes and other transportation accidents rose 43.5% over that same stretch.

What surprised even close followers of these trends is how much of the damage now comes from disease rather than injury. Deaths from diabetes and other metabolic and hormone-related illness rose nearly a quarter between 2010 and 2019 among young adults. Deaths tied to liver damage from drinking more than doubled between 2010 and 2023. Deaths from alcohol-related mental health disorders more than tripled in that same window. Even high blood pressure, historically a problem of later adulthood, saw its death rate more than double among 25- to 44-year-olds between 2000 and 2023.

Middle-aged adults, 45 to 64, saw many of the same patterns: rising deaths from drug overdoses, liver damage from drinking, and diseases of the brain and nervous system, along with a COVID-19 death rate that nearly doubled between 2020 and 2021 even after vaccines became available. Older adults largely avoided these steep increases, though deaths from brain and nerve diseases doubled between 2000 and 2023, and deaths from endocrine disorders and suicide also climbed.

Where U.S. Life Expectancy Has Fallen the Furthest

National averages hide some brutal local realities. Comparing individual states to countries with similar life expectancy, Woolf found that Hawaii, the top-performing state, matched life expectancy in Western European countries like Sweden and Ireland. Mississippi, by contrast, resembled Libya, Venezuela, Belarus, and Syria in 2019. Conditions worsened after the COVID-19 pandemic hit. By 2021, life expectancy in West Virginia and Mississippi matched Bulgaria, Bangladesh, and Iraq, and fell below North Korea and Syria. Life expectancy was higher in Palestine and Iran than in nine U.S. states, including Oklahoma, Tennessee, Kentucky, Alabama, and Mississippi.

Woolf’s review of state data going back to 1941 found that states led by Republican governors tended to see life expectancy stagnate or decline, a pattern that became especially visible after 2010 and turned into what Woolf calls a “natural experiment” during the COVID-19 pandemic. States’ sharply different decisions on masking, business closures, and vaccination, he writes, could be measured in death counts within weeks. Red states, the analysis notes, suffered the largest COVID-era drops in life expectancy, a pattern that held up even after researchers accounted for other factors like poverty rates and existing health conditions.

Other researchers cited in the review, who looked at generational patterns rather than state policy, found that Americans born after 1970 had higher death rates from heart disease, cancer, and injury-related causes than earlier generations. They concluded that the current stall in U.S. life expectancy stems from “multilayered social, biological, and generational forces.”

Why America’s Death Rates Keep Climbing

Woolf’s analysis lays out five broad categories behind America’s health disadvantage: a health care system without universal coverage, riskier individual behaviors like higher calorie consumption and firearm ownership, greater income inequality and poverty, a built environment that favors cars over walking and green space, and public policies that put less emphasis on collective welfare than peer nations do. None of these explanations are new, but the paper argues that treating overdoses, suicides, and chronic disease as separate problems misses the bigger picture: they are symptoms of the same underlying neglect.

That’s the sharpest point in the paper, and probably the one worth sitting with. Other wealthy countries didn’t stumble into longer lives by accident. They built universal health coverage, stronger safety nets, and tighter consumer and environmental protections decades ago, and it shows up in their citizens’ death certificates today. America’s problem was never a shortage of ideas for fixing this. It’s a shortage of political will to act on them, and until that changes, the gap between how long Americans live and how long people in dozens of other countries live looks likely to keep growing.