Researchers at Brown University’s School of Public Health found that from 2009 to 2021, avoidable deaths increased in every U.S. state, even as they declined in most other high-income countries.
When someone dies, medical professionals often examine the cause of death to assess whether it might have been preventable, either through public health measures like vaccination or through timely medical treatments such as antibiotics. These are referred to as avoidable deaths or avoidable mortalities. In most high-income countries, the number of these deaths has been steadily declining.
However, in the United States, avoidable deaths have been increasing for more than a decade. A recent study by researchers at the Brown University School of Public Health and Harvard University, published in JAMA Internal Medicine, highlights this troubling trend.
The researchers analyzed mortality data from all 50 U.S. states and compared it with data from 40 other high-income countries, including members of the European Union and the Organization for Economic Cooperation and Development (OECD), which includes nations like Australia, Japan, and Iceland. Their findings showed that from 2009 to 2021, avoidable mortality worsened in the U.S., while it generally improved in the EU and OECD countries—except during the COVID-19 pandemic period from 2019 to 2021.
A Different Path from Other High-Income Nations
The findings suggest that deep-seated issues in the American health care system and public policy may be contributing to worsening health outcomes, said lead study author Irene Papanicolas, a professor of health services, policy, and practice at Brown’s School of Public Health.
“We’ve known for some time that life expectancy has been getting worse in the U.S., but now we can see that the country is on a different trajectory from other high-income countries,” said Papanicolas, who is also the director of the Center for Health System Sustainability. “Other countries are getting better at reducing avoidable deaths through prevention and treatment, but in the U.S., these deaths are growing.”
The researchers compared mortality data from individual U.S. states to data from high-income countries of similar scale, and also used aggregate data to compare the U.S. overall to the aggregates of other countries.
On average, avoidable mortality increased across the U.S. by 32.5 avoidable deaths per 100,000 people. By contrast, avoidable mortality decreased in EU countries by 25.2 avoidable deaths per 100,000 people and decreased in OECD countries by 22.8 avoidable deaths per 100,000 people.
“It’s a bit shocking,” Papanicolas said. “What we found is that while avoidable mortality varies by state, all U.S. states are getting worse.”
In New York, for instance, avoidable mortality from 2009 to 2019 increased by 4.9 deaths per 100,000 people; in West Virginia, avoidable mortality increased by 99.6 deaths per 100,000 people.
Broad Increases Across Preventable Causes
When the researchers examined the causes of avoidable deaths (including road traffic accidents, illnesses preventable by vaccines, treatable conditions like sepsis or appendicitis, and conditions preventable by early detection and treatment like cervical cancer, ischemic heart disease and tuberculosis), they found that deaths from a variety of different causes are rising in every U.S.
“There’s been a lot of discussion about preventable deaths in the U.S., such as drug-related deaths or suicides, which do account for a big proportion of this trend,” Papanicolas said. “However, we found that deaths from nearly all major categories are increasing.”
An exception, she noted, is that death rates from cancer are decreasing in some U.S. states.
The team found no clear association between health expenditures and avoidable mortality in the U.S., meaning that states that spend more on health care don’t necessarily fare better. On the other hand, in the high-income countries evaluated in the study — including Canada, Japan, Spain, and Turkey — there was a correlation between higher spending on health care and better outcomes in terms of avoidable mortality.
These findings are particularly concerning, Papanicolas said, because the U.S. spends more on health care per capita than any other country in the analysis.
“The results point to systemic factors that the U.S. and all its states are dealing with,” she said.
The analysis involved mortality data for people under the age of 75 from the Centers for Disease Control and Prevention and from the World Health Organization. Health spending data came from the U.S. Census Bureau, the Centers for Medicare and Medicaid Services, the Office of the Actuary, and from the WHO Global Health Expenditure Database.
This study, which builds on previous research by this team, serves as a call to action for U.S. policymakers to address this growing mortality gap, Papanicolas said.
Moving forward, she said, the researchers plan to investigate what the U.S. can do better.
“It’s really interesting to see how the U.S. is different, but where we want to explore next is what other countries are doing that the U.S. can do to bring down avoidable deaths,” she said.
Reference: “Avoidable Mortality Across US States and High-Income Countries” by Irene Papanicolas, Maecey Niksch and Jose F. Figueroa, 24 March 2025, JAMA Internal Medicine.
DOI: 10.1001/jamainternmed.2025.0155
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4 Comments
We can fix this! You know what we need?
More laws, mandates, control. Let the government take control and tell us what to do, what to eat, what type of medical care to get.
Stop eating whole, natural, and organic foods. We need more “vegan” and insect alternatives. More processed food made in labs and factories.
Why cant anyone see this? Its right here in our faces!
There is a bias in this presentation of the problem. It is assumed that medical care can reduce “avoidable” deaths, and this makes it surprising that the US spends more on healthcare but gets worse results. However, the real problem is the type of healthcare offered. Over-medicalization is a problem, and doctor-caused (iatrogenic) deaths are huge causes of “avoidable” deaths. Adverse drug side effects and doctor errors are considered the third largest cause of death. And given the extremely high cost of US medical care and drugs, this leads to a system that charges a lot of money to kill you with medical “care”.
The fact that this study completely ignored iatrogenic disease is telling. Given that the profit motive guides the US medical establishment, the medical industry is rewarded when there is more disease. The worse our health, the more they make. This is why this problem will not go away.
“Avoidable death” is pretty silly expression. No death can be avoided. It can perhaps be delayed sometimes.
But if you tell me vaccines can prevent death, I’ll point it out to you that they can also cause it.
After the miserable performance around “safe and effective” COVID-19 vaccinations, discussions of the origins of COVID-19, idiotic implementation of destructive measures in the name of public safety I am surprised anybody must ask this question. Could they have managed to do worse before being discovered than what they did? Why might that be? Accident? Malign? Either way our medical care is way below what we are paying for. Cui bono?
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