Avoidable deaths rising in US while declining in other countries

Key takeaways:

• Avoidable mortality rose by 32.5 deaths per 100,000 people in the U.S. from 2009 to 2019.
• A study author told Healio this increase was largely driven by preventable deaths, such as fatal drug overdoses.

Deaths that could have been avoided have significantly risen in the United States over the last decade-plus, an analysis in JAMA Internal Medicine revealed.

This trend contrasted those experienced by other high-income countries up until the start of the COVID-19 pandemic.

Irene Papanicolas, PhD, a professor of health services policy and practice at Brown University, told Healio that the difference between the U.S. and other countries, “and that the trajectory of increases in avoidable mortality was common across all states,” came as a surprise.

According to Papanicolas and colleagues, avoidable mortality is defined as death in people aged younger than 75 years that could have been avoided through timely and effective prevention or health care.

They added that avoidable mortality can be further divided into two types: preventable mortality — deaths that could have been prevented through effective public health and health promotion strategies like vaccination — and treatable mortality — “deaths that may be avoided with timely and effective medical care.”

The researchers utilized 2009 to 2021 CDC and WHO data to see how the U.S. fared in avoidable mortality vs. 40 other high-income countries in the European Union (EU) or Organization for Economic Co-operation and Development (OECD) during that period.

From 2009 to 2019, avoidable mortality rose across all U.S. states and Washington, D.C. — increasing by 32.5 avoidable deaths per 100,000 people — but decreased by 23.9 per 100,000 among EU countries and by 19.1 per 100,000 among OECD countries.

Avoidable mortality during that period significantly varied by state, ranging from 4.9 per 100,000 in New York to 99.6 per 100,000 in West Virginia.

Avoidable mortality continued to rise across all U.S. states, in addition to nearly all EU and OCED countries, from 2019 to 2021.

Papanicolas noted that the rise in avoidable deaths was “largely driven by preventable mortality, particularly external deaths,” such as those caused by drug overdose, suicide and alcohol.

Specifically, fatal drug overdoses contributed to 71% of the increase in avoidable deaths from external causes in the U.S. from 2009 to 2019.

“However, there are increases also in treatable mortality, mostly in circulatory system deaths,” Papanicolas told Healio. “These causes of deaths were mostly falling in comparator countries.”

According to a press release, the researchers found no association between health expenditures and avoidable mortality in the U.S. However, a link between greater health care spending and better outcomes in avoidable deaths was observed in countries like Canada, Japan and Spain.

Papanicolas explained that avoidable mortality, particularly preventable mortality, “is something that should be targeted mostly through public health measures and the social determinants.”

“Other countries have more measures in place around the taxation of alcohol, firearm regulation and more generous social safety nets,” she said. “For treatable mortality, we need to better understand why circulatory system deaths are increasing and work on ensuring populations with risk factors, such as hypertension and diabetes, are getting treatment.”

Regarding future research, “we are interested in looking into… where the U.S. and states have policies that are similar and different to these other countries to better understand how some of these factors are related and what can be adopted to see health gains,” Papanicolas said.

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