Avoidable Mortality Across US States and High-Income Countries

Investment Analysis Clubs Macro Economic Trends and Risks
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The most fundamental Macroeconomic issue: is a consumer alive or dead?

Avoidable Mortality Across US States and High-Income Countries

JAMA Intern Med. Published online March 24, 2025
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2831735?guestAccessKey=6e140777-9347-46e6-bc5d-f78fca5cb2ee&utm_term=032425&utm_campaign=ftm_links&utm_medium=referral&_hsenc=p2ANqtz-8nZQzEL0aZanYb_ag6WWg1M_S4797v_J9HrxY_k4Ll-yiTLLdgbSsxV3azd96htCAZK1ySvg5zRpH5vBvbfTIT6OLAwQ&_hsmi=353393995&utm_content=tfl&utm_source=for_the_media

Question How did avoidable mortality vary across US states compared with 40 high-income countries between 2009 and 2021?

Findings
In this retrospective study, between 2009 and 2021, avoidable mortality increased in all US states, primarily due to increases in preventable deaths, while it decreased in comparable high-income countries. Health spending was significantly negatively associated with avoidable mortality for other high-income countries but not across US states


Design, Setting, and Participants
Retrospective, population-based, repeated cross-sectional study comparing changes in avoidable mortality among decedents aged 0 to 74 years in 50 US states (and Washington, DC) and 40 high-income countries between 2009 and 2021


Results Between 2009 and 2019, total avoidable mortality increased in all US states (median [IQR], 29.0 [20.1 to 44.2] deaths per 100 000 people), while it decreased in most comparator countries (−14.4 [−28.4 to −8.0]). During this period, variation in avoidable mortality widened across US states (2009: median [IQR], 251.1 [228.4 to 280.4]; 2019: 282.8 [249.1 to 329.5]), but narrowed in comparator countries (2009: 201.5 [166.2 to 320.8]; 2019: 187.1 [152.0 to 298.2])
 Life expectancy across US states varies just as markedly as it does across high-income countries, from 81.8 years in HawaiÊ»i to 74.7 years in Mississippi in 2019


Avoidable mortality can further be divided into preventable and treatable mortality


In the US, most of the increase in the 2009 to 2019 period was in preventable mortality
Avoidable mortality in US states between 2009 and 2019 was mostly due to increased avoidable deaths from external causes (eg, traffic collisions, homicides, suicides, and drug- and alcohol-related deaths)


We found a clear negative association between health expenditures and avoidable mortality across the comparator countries [that is, the more they spent the less mortality they had]. However, across US states, there was no significant association between health expenditures and avoidable mortality


Avoidable mortality in the US appears to have been disproportionately driven by preventable mortality, which is influenced by socioeconomic factors and public health policy. This underscores the necessity for a multisectoral approach to improve US population health. For example, policies promoting access to healthy foods, limiting exposure to harmful products, and combating obesity can significantly reduce the risk and incidence of chronic diseases. Legislative measures addressing gun violence can lower injury-related deaths. Regulations on motor vehicle safety can prevent collisions and deaths
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This is an important article which is packed with data.

Medical treatments have been improving so mortality from some preventable diseases (cardiovascular, cancer) have been at least partially offset by better treatment.

The real increase in premature mortality is driven by lifestyle factors which are very difficult to change. Spending more money on healthcare isn’t going to stop people from eating junk food, drinking alcohol, smoking cigarettes, taking drugs, avoiding seat belts and shooting each other.

It’s no surprise that premature mortality is worse in poor areas of the U.S. which may as well be different countries compared with the wealthy areas that have more economic opportunity, better access to medical care and different cultures. “Deaths of despair” (drugs, alcohol, suicide) are concentrated in areas that lost well-paid jobs over the past 20 years.

The sad Macroeconomic trend of increased avoidable mortality in the U.S. is continuing and hard to reverse. There is a clear difference between comparable wealthy countries and the U.S. which is attributable more to culture than to the lack of medical care.

Wendy

4 Likes
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I think the question is can you avoid the culture, or are you chained to it?

My presumption would be that when a Mississippi billionaire gets sick, he gets in the private jet and flies off to the Mayo Clinic or Johns Hopkins, and thus would have the life expectancy of other global billionaires. During Covid it wasn’t unusual to see Red State elites championing “freedom” and anti-vax lingo while sending their own kids to private schools where vaccines were mandatory and everyone was masked up.

intercst

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2009-2019. Did not cover Covid time frame. Be more interesting to see the 2019-2029 analysis–if we are allowed to live that long.

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The article discusses Covid but that distracts from the underlying trend.
Wendy

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Proper use of knife and fork lowers costs and delays mortality.

The Captain

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We can see what takeaway the “JCs” have, from that question. They shift their focus to selling higher priced products and services, in lower quantity, to the shrinking portion of the population that has an increasing proportion of the loot. We see that in housing: mcmansions instead of the smaller homes that dominated in the 50s and 60s. We see that in cars, where Ford boasts it will charge Porsche prices, VW bragging they will charge Audi prices, and Audi pushing prices into Bentley territory. Do less and make more money, while closing factories and laying off “redundant” Proles in the tens of thousands.

Steve

2 Likes