Causes of Excess Deaths in the US Compared With Other High-Income Countries

The US has higher mortality rates than other high-income countries (HICs). However, a comprehensive analysis of excess US deaths encompassing all leading causes of death over the past 2 decades is currently lacking.

To investigate causes of death responsible for excess US mortality compared with other HICs and how the causes of death involved in this US mortality disadvantage have changed over time.

This repeated cross-sectional study included mortality data from the World Health Organization Mortality Database spanning 1999 to 2022 for the US and 17 other HICs. Data were analyzed from September 2023 to December 2025.

Residing in the US vs another of the included HICs.

The main outcome was excess US mortality in each year due to specific causes of death. Differences between the US and other HICs were quantified for each cause of death as (1) excess US deaths (ie, absolute difference between observed deaths and deaths expected if US death rates equaled the rates of other HICs); (2) years of life lost (YLL) resulting from excess US deaths; and (3) mortality rate ratios (ie, ratios of observed to expected age-standardized death rates).

A total of 63 547 318 deaths occurred in the US from 1999 to 2022 (50.4% among males; mean [SD] age at death, 73.2 [18.5] years). In this period, 12 675 646 excess US deaths occurred, increasing from 346 166 in 1999 to 905 159 in 2022. Circulatory diseases were the leading cause of excess US deaths every year except 2010, increasing after 2001 for ages 45 to 64 years and after 2009 for ages 65 years or older. Together, circulatory and metabolic diseases accounted for 52% of excess US deaths in 2022. Excess US deaths due to drug poisonings, alcohol, and suicide increased from -5762 in 1999 to 131 151 in 2022; together, these 3 causes accounted for 24% of the increase in excess US deaths overall and most of the increase in excess US deaths for individuals aged 0 to 44 years. In 2022, deaths from drug poisonings were 7.48 times higher in the US than in other HICs. In 2020 and 2021, 19% and 23% of excess US deaths, respectively, were attributed to COVID-19, but excess US deaths from other causes also increased.

In this repeated cross-sectional study of cross-national mortality, the US had substantially higher death rates than other HICs between 1999 and 2022, despite having similar access to advanced medical technology. Many of these excess US deaths could likely be avoided by adopting health and social policies that have benefited other HICs. These descriptive findings should be interpreted in light of uncertainty arising from differences in death coding, data completeness, and other aspects of data comparability across countries.