Each year, the United States has hundreds of thousands of deaths that could have been averted, according to a new collaboration between researchers at Boston University, Hunter College and the Minnesota Population Center. 

The U.S. is one of many nations considered wealthy, with the World Bank defining a wealthy nation as one with an average gross national income per capita of $14,005 or above. 

If death rates in the U.S. matched those of other wealthy nations, according to the study, the country would see far fewer deaths from avoidable diseases and accidents, or excess deaths. 

These excess deaths have continued to rise steadily over four decades, even in the post-pandemic era, said Jacob Bor, lead author of the study and associate professor at the Boston University School of Public Health.

“As the highest income and wealthiest country in the world, surely we should be at least average in terms of health outcomes?” Bor said.

The researchers estimate that between 1980 and 2023, excess deaths, or “missing Americans,” totaled 14.7 million in the United States. Bor says he hopes that quantifying these numbers can attract the attention of policymakers. 

“Being able to see that almost half of deaths under 65 could be averted if the US had the mortality rates of our peers, it highlights the very human costs of this,” Bor said. “The amount of grief and trauma that Americans are experiencing as a result of this … takes your breath away.”

While mortality increased worldwide during the pandemic, the disparity between the U.S. and other wealthy nations reached a peak in 2021, as the climb in deaths was much more pronounced in the United States. 

Although excess deaths declined from 1.1 million in 2021 to just over 700,000 in 2023, the recent numbers are consistent with the previously rising pre-pandemic trend.

“This actually is not a pandemic or a postpandemic story,” associate director of the Minnesota Population Center Elizabeth Wrigley-Field said. “This is a story about a longer-term trend, and we’re exactly on the line that you would expect us to be on, just based on the fact that things have gotten worse every year for America in relation to our peer countries.” 

Though the study did not uncover the specific determinants of the trend, the researchers speculated that it may be attributed to the United States’ comparatively poor social and healthcare infrastructure.

“Other high-income countries have more robust social safety nets,” Bor said. “Most of them have universal health care. Most of them have much more restrictive policies around firearms.”

The study is a part of a series of research collaborations, each uncovering a different piece of the post-COVID-19 mortality puzzle in the United States. 

The earliest project in the series examined how racial, ethnic and geographic disparities in mortality have shifted post-pandemic, with the study finding that most of the disparities spiked during the height of the pandemic and then returned to pre-pandemic levels. 

However, the increased mortality gap between metropolitan and nonmetropolitan Americans persisted even after the peak of the pandemic. The authors suspect this disparity could be due to rural hospital closures, healthcare worker burnout and vaccine hesitancy.  

The next steps for the research group are to identify the specific mechanisms and pathways underlying the United States’ mortality disadvantage, co-author and Boston University Demographer Andrew Stokes said. 

“Are they missing because of traffic accidents? Are they missing because of cardiometabolic diseases or drug poisoning?” Stokes said.  

Bor is concerned that proposed federal spending cuts to public health infrastructure and social programs like Medicaid and the Supplemental Nutrition Assistance Program could exacerbate the trend. 

“Our lesson from these data is that we should really be investing in the health of Americans,” Bor said. “What we’re seeing from the new administration is further divestment from the health of Americans.”