A major new analysis finds U.S. life expectancy falling behind other high-income countries and identifies a widening set of chronic diseases — not only overdoses and violence — as key drivers. Adults aged 25–44 saw a 71.2% rise in all-cause mortality from 2010 to 2021. Experts attribute the trend to barriers in access, affordability and prevention, along with social and environmental factors, and call for policies that address both medical care and broader determinants of health.
Study: U.S. Life Expectancy Lags — Chronic Diseases and Barriers to Care Widen the Gap
A young woman looks out over water, a child sits on a man's shoulders and raises the American flag, and headstones are seen in a cemetery.
New research finds Americans are dying at higher rates than peers in other wealthy nations — and the gap goes well beyond drug overdoses and other "deaths of despair." The analysis shows an expanding range of chronic illnesses is driving a growing U.S. mortality disadvantage.
What The Study Found
Dr. Steven Woolf of Virginia Commonwealth University's School of Medicine, the study's corresponding author, identified rising deaths from hypertensive disease, endocrine and metabolic disorders, alcoholic liver disease, neurologic conditions and genitourinary diseases as major contributors to the widening life-expectancy gap. The study compared U.S. mortality from 1999 to 2023 with 16 other high-income countries using data from the United Nations, the U.S. Mortality Database, the Centers for Disease Control and Prevention and the OECD.
In 2023 the United States ranked 38th in life expectancy among countries with populations over 1 million, and residents of 60 countries faced a lower risk of dying before age 40 than Americans.
Shifts by Age Group
Among adults aged 25–44, all-cause mortality rose 71.2% between 2010 and 2021. That surge reflects not only drug overdoses, suicides and homicides, but also sharp increases in early-onset chronic conditions such as hypertensive disease, endocrine and metabolic disorders, and alcoholic liver disease. Middle-aged adults experienced rising deaths from many of the same causes plus higher mortality from nervous system and genitourinary diseases. Older adults saw growing mortality from neurologic diseases and metabolic disorders.
External Causes and COVID-19
While external causes (overdoses, suicides, homicides) remain important drivers of excess U.S. deaths, the researchers emphasize these causes do not fully explain the country’s health disadvantage. COVID-19 exacerbated trends — becoming a leading cause of death for middle-aged and older adults during the pandemic — but non-COVID causes continued to drive excess mortality even after the pandemic’s worst phase subsided.
Expert Analysis: Systemic Problems Behind the Numbers
"When people forgo care because of cost, the probability of addressing a health condition in time decreases, which can lead to higher mortality rates," said Mónika López Anuarbe, a health economist at Connecticut College, highlighting how access, cost and quality (the "iron triangle" of health care) shape outcomes.
Jagdish Khubchandani, a public health professor at New Mexico State University, noted the paradox that the U.S. spends more on health care than any nation yet lags many peers in mortality. He pointed to preventable drivers — overdoses, suicides, alcohol-related liver disease and heart disease tied to high blood pressure — and broader contributors such as a fragmented health system, obesogenic food environments and weakening social safety nets.
What Might Close the Gap
The study recommends tackling broader determinants of health: expand timely access to affordable care, strengthen prevention (including substance-use interventions and cardiovascular risk reduction), and address socioeconomic, environmental and structural inequalities that increase vulnerability to chronic disease.
Reference: Woolf, S. H. (2026). U.S. Life Expectancy and Increasing Mortality Rates: An Analysis of the Crisis. The Milbank Quarterly. https://doi.org/10.1111/1468-0009.70118.
Image caption: A young woman looks out over water; a child waves an American flag; headstones at a cemetery illustrate the human toll behind the data.
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