Early Adult Death Rising in the US: Pre- and Postpandemic Trends

Early adult death in the US has significantly increased since 2010, with mortality rates exceeding pre-pandemic levels, even in 2023. | Image Credit: Matt Jones - stock.adobe.com

Despite improvements in life expectancy for much of the 20th century, early adult mortality in the US has taken a sharp turn, with a substantial increase in deaths among young adults, according to a study published in JAMA Network Open.1

Many US population groups have experienced stalled or reversed mortality rates since 2010. High-income countries, like the US, have increased life expectancy at birth of about 3 years per decade throughout the majority of the 20th century.2

Interruptions in pattern improvement during the mid-20th century stagnated midlife male mortality. Additionally, women aged 25 to 44 years in the US had higher all-cause mortality rates in 2019 compared with 1990.3

Exposure to harmful working conditions, fatty diets, and smoking habits accelerated, and some researchers have attributed the slight stagnation in life expectancy gains to the health-related experiences of the cohorts involved.2 From 2010 to 2019, substantial reductions in the rate of mortality improvement in the United Kingdom (UK), US, and other industrialized countries have prompted intense debate among researchers.

In the current study, researchers claimed that “few studies have focused on early adulthood (ages 24-44) specifically—the period during which many health behaviors are established.”1 They conducted a cross-sectional study to analyze monthly mortality rates using cause-specific death counts from the CDC WONDER queries and midyear population estimates from the US Census Bureau for adults aged 25 to 44 years between 1999 and 2023.

The study analyzed 3,392,364 deaths among the full US population aged 24 to 44 years between 1999 and 2023. Increased mortality from most causes of death led to substantial excess deaths compared with extrapolations of pre-2011 trends.

In 2019, early adult excess mortality was 34.6% higher than expected and accelerated during the COVID-19 pandemic. By 2021, all-cause excess mortality was nearly 3 times what it had been in 2019 (116.2 vs 41.7 deaths per 100,000). Excessive mortality decreased in 2023 but only to approximately midway between its 2019 and 2021 levels (79.1 deaths per 100,000).

Early adult mortality in 2023 was 70% higher than pre-2011 trends, reflecting 71,124 excess deaths. Drug poisoning (31.8%), the residual natural-cause category (16%), transport-related deaths (14.1%), alcohol-related deaths (8.5%), and homicide (8.2%) collectively caused almost three-quarters of the early adult excess mortality in 2023. The combined contribution of cardiometabolic conditions, including circulatory and endocrine, metabolic, and nutritional, was substantial (9.2%).

Early adult mortality in the US has increased in 2 stages: 2011 to 2019 and 2020 to 2023. Despite mortality rates decreasing after the core pandemic years, excess mortality remained higher than predicted based on prepandemic levels. In 2023, excess mortality was largely driven by drug poisoning, but other factors exceeded prior trends that would have been projected.

Using provisional mortality data for 2023 and examining aggregate trends rather than distinct subpopulations defined by race, ethnicity, and gender limited the study.

Future research should emphasize the previous discussions from experts regarding the impact of health insurance on patients’ access to care services and improved health-related outcomes, based on results from previous research.3

Study results acknowledge the potential of a worsening mortality crisis, which could lead to population risks unless trends are reversed.1 Policy solutions demand attention to the underlying causes of intensifying excess mortality among early adults, the authors stated.

References

1. Wrigley-Field E, Raquib RV, Berry KM, Morris KJ, Stokes AC. Mortality trends among early adults in the United States, 1999-2023. JAMA Netw Open. 2025;8(1):e2457538. doi:10.1001/jamanetworkopen.2024.57538
2. Murphy MJ, Grundy EMD. Slowdown in mortality improvement in the past decade: a US/UK comparison. J Gerontol B Psychol Sci Soc Sci. 2022;77(2):S138-S147. doi:10.1093/geronb/gbab220
3. Santoro C. ACA impact on Medicare beneficiaries linked to reduced cost, improved health. AJMC®. January 17, 2025. Accessed January 30, 2025. https://www.ajmc.com/view/aca-impact-on-medicare-beneficiaries-linked-to-reduced-costs-improved-health