Avoidable Mortality Across US States and High-Income Countries

Area of Science:

• Public Health
• Health Policy
• Comparative Health Systems

Background:

• Increasing disparities in US health policy and population health over the past decade.
• Limited understanding of how US states compare internationally on avoidable mortality rates.

Purpose of the Study:

• To compare trends in avoidable mortality between US states and high-income countries in the European Union (EU) and the Organisation for Economic Co-operation and Development (OECD).

Main Methods:

• Retrospective, population-based, repeated cross-sectional study.
• Compared avoidable mortality (preventable and treatable deaths) in individuals aged 0-74 years.
• Analyzed data from 50 US states and Washington, DC, and 40 high-income countries between 2009 and 2021.

Main Results:

• From 2009-2019, avoidable mortality increased in all US states but decreased in most comparator countries.
• Variation in avoidable mortality widened across US states while narrowing in comparator countries.
• During COVID-19 (2019-2021), avoidable mortality increased in both US states and comparator countries, with the highest increases in areas with higher baseline mortality.
• A significant negative association between health spending and avoidable mortality was observed in comparator countries, but not in US states.

Conclusions:

• The contrasting trends suggest broad, systemic factors contribute to worsening US population health.
• Other countries demonstrate health gains with increased healthcare spending, unlike US states, questioning US health spending efficiency.