12.7 Million US Deaths Linked to Two Key Factors, Study Finds

Between 1999 and 2022, roughly 12.7 million deaths in the United States could have been avoided if the country's mortality rates matched those of 17 other wealthy nations, according to a comprehensive analysis of over 63 million fatalities. The study identifies two primary drivers behind the widening life expectancy gap: soaring rates of cardiovascular and metabolic diseases, and a sharp rise in so-called "deaths of despair" linked to drugs, alcohol, and suicide.

Americans are dying at younger ages than their counterparts in nations like Japan, Switzerland, and Australia, a trend that researchers say is accelerating. The annual number of "excess deaths" in the U.S. more than tripled over the 23-year period, jumping from approximately 346,000 in 1999 to 905,159 in 2022.

Cardiovascular and Metabolic Crisis

Circulatory system diseases—including heart attacks and strokes—were the leading contributor to excess deaths in nearly every year studied. While U.S. mortality rates for these conditions improved between 1999 and 2009, the trend reversed sharply from 2009 onward, even as other wealthy nations continued to see declines. The rise in circulatory deaths among adults aged 45 to 64 began a full decade earlier than among older adults, suggesting long-term population-level factors such as rising obesity rates and dietary shifts are at play.

Dr. Neil Shah, a cardiologist at Northwell Health, told the New York Post: "As we look into this, we find—as this paper appropriately points out—that the amount of cardiovascular disease and mortality starts at a younger age compared to older adults." He added, "To address this, I think we as a country, from a policy standpoint, need to figure out how we're going to provide patients with the preventive care and preventive screening necessary so that we can use the medications and counseling that make a real difference early on to prevent these downstream cardiovascular outcomes."

A similar pattern emerged for diabetes, kidney disease, and other metabolic conditions. Excess deaths from these causes remained relatively stable through the early 2000s before spiking after 2010 and continuing through 2022. By 2022, U.S. death rates from circulatory and metabolic diseases were 1.63 and 2.25 times higher, respectively, than in peer nations. Together, these conditions accounted for more than half of all excess deaths.

Shah, who was not involved in the new research, explained: "This is all a common cardiometabolic continuum and not separate, isolated diseases; or in other words, each of these things affects the other."

Deaths of Despair on the Rise

While circulatory and metabolic diseases made up the largest share of excess deaths over the study period, the fastest-growing category was "deaths of despair," particularly among men. In the U.S., fatalities from drug poisoning, alcohol-related causes, and suicide rose from levels similar to peer nations in 1999 to more than 130,000 excess deaths in 2022 alone. These deaths were the primary driver of the widening mortality gap for people under 45.

Dr. Javier Jimenez, director of consultative psychiatry and addiction and chronic pain medicine at Northwell Lenox Hill Hospital, described "'deaths of despair' as an umbrella term for a number of behavioral, psychological, and social factors that drive individuals to certain unhealthy behaviors and maladaptive coping strategies that have health consequences, including death." He elaborated: "It can be a range of things; it could be substance use to escape their reality, or poor nutrition, or bad social decisions, or not seeking mental health care, and maybe escaping through a variety of other behaviors that accumulate later on. This ultimately leads to death, unfortunately."

Jimenez added: "This study is striking, and frankly, I am not surprised by the findings; behavioral health concerns that are not addressed accumulate in individuals and contribute to a huge slice of deaths via overdoses, impulsive behaviors, suicide, violence, and accidents."

Deaths from cardiometabolic diseases and from drugs, alcohol, and suicide together accounted for about 24% of the increase in excess deaths during the study period, with most of the rise occurring among those under 44.

Pandemic and Broader Trends

The COVID-19 pandemic caused a sharp spike in excess deaths in 2020 and 2021, with the virus accounting for roughly 1 in 5 excess deaths during that period. Researchers also found increases in other causes during the pandemic, including circulatory diseases, metabolic conditions, drug poisonings, and alcohol- and suicide-related deaths. They suggested this may reflect disruptions in medical care, worsening mental health, broader social stresses, and, in some cases, misclassification of COVID-related deaths as other causes.

Despite these trends, the latest data shows an American born in 2024 can expect to live to about 79 years on average—the highest level since national tracking began in 1900. However, that still lags behind peer nations such as Switzerland, where life expectancy is about 84 years, and Japan, where it is about 85 years.