Analysis of the non-natural deaths of US citizens while abroad

Studies on fatal injury of US citizens abroad have focused on estimating proportional mortality ratios (PMRs) by region and country and often show that travellers have a higher risk of fatal injury than the local population. Our objective was to assess the extent to which this risk has changed over time and whether any changes vary by region. In our view, exploring such changes can enhance travel advisories.

To improve our understanding of whether the risk of deaths of US citizens abroad, had changed we used data from the US Department of State-Bureau of Consular Affairs, the World Health Organization and the US Department of Transportation to conduct two-way analysis of variance (ANOVA) regressions, on PMRs across two periods namely 2003 to 2012 and 2013 to 2022 period and regions. Regions were defined in line with the World Bank income classifications schema. We also conducted the same assessment on a US death per 100 000 US passenger statistic.

PMR ratios have increased over the 10-year period 2013-2022 from the prior 10-year prior 2003-2012 for vehicular and non-vehicular accidents, while being stable for drownings, suicides and other causes of death. PMR ratio also appears to vary by region.

The higher risk of fatal injury for vehicular and non-vehicular accidents is concerning and suggests that policy responses are needed to address the increase. This development is also occurring within an environment of stable and declining absolute numbers of US deaths for these two categories. We find that an increase in US deaths for vehicular and non-vehicular accidents post-2020 lows, coupled with a non-resurgence of domestic deaths, in these two areas, could explain why their PMRs increased.