Missing Americans: Early death in the United States

Missing Americans: Early death in the United States—1933–2021


We assessed how many US deaths would have been averted each year, 1933–2021, if US age-specific mortality rates had equaled the average of 21 other wealthy nations. We refer to these excess US deaths as “missing Americans.” The United States had lower mortality rates than peer countries in the 1930s–1950s and similar mortality in the 1960s and 1970s. Beginning in the 1980s, however, the United States began experiencing a steady increase in the number of missing Americans, reaching 622,534 in 2019 alone. Excess US deaths surged during the COVID-19 pandemic, reaching 1,009,467 in 2020 and 1,090,103 in 2021. Excess US mortality was particularly pronounced for persons under 65 years. In 2020 and 2021, half of all US deaths under 65 years and 90% of the increase in under-65 mortality from 2019 to 2021 would have been avoided if the United States had the mortality rates of its peers. In 2021, there were 26.4 million years of life lost due to excess US mortality relative to peer nations, and 49% of all missing Americans died before age 65. Black and Native Americans made up a disproportionate share of excess US deaths, although the majority of missing Americans were White. [end quote]

Deaths of despair – drug use, alcoholism and suicide. Gun violence. Chronic and acute disease.

According to the Institute for Health Metrics and Evaluation, there are 22 times as many gun-related homicides in the United States as in the countries of the European Union. Between 2019 and 2021, total U.S. gun deaths — including suicides and accidents — [grew 23 percent] to 48,830 such deaths in 2021.

In 2019, the “Missing Americans” authors calculate, the United States had almost twice as many deaths among those under the age of 15 than in its peer countries. And instead of approximately 70,000 deaths among those aged 15 to 44, as would be implied by peer-average mortality rates, there were more than 170,000.

During the Covid pandemic, across the other wealthy nations, age-standardized mortality among those under the age of 65 increased by six deaths per 100,000 between 2019 and 2021. In the United States, those rates grew by 254 deaths per 100,000 among Native Americans, 143 deaths per 100,000 among Black Americans, 108 deaths per 100,000 among Hispanic Americans, 72 deaths per 100,000 among white Americans and 36 deaths per 100,000 among Asian Americans.

Mortality rate ratios relative to other nations increased over time for all race/ethnicities, indicating worsening position relative to other wealthy nations. Mortality rate ratios were largest among younger adults, indicating that the pattern of elevated early- and mid-life US mortality is not limited to one specific race or ethnicity.

In 2020 and 2021, more than half of all US deaths under 65 years would have been averted if the United States had experienced the mortality rates of its peers. During the first two years of the COVID-19 pandemic, there were nearly 1 million excess US deaths under 65 years. The 1.1 million missing Americans in 2021 would have enjoyed an estimated 26.4 million additional years of life had they survived.

The authors chose to compare the U.S. to other countries of similar economic status (mostly in Europe) rather than the usual excess mortality compared with the U.S. in earlier years. This is because the U.S. has had growing excess mortality compared with these other countries since 1980 so self-comparison hides a lot of excess deaths. The study showed that even before the pandemic, the United States experienced more than 600,000 excess US deaths each year, with most occurring among Americans under 65 years.

In an aging population, Macroeconomic trends require a healthy, young work force to maintain the promised level of benefits. Aside from the tragic suffering of the missing Americans, our economy is weakened by their loss.

The article ends with a long list of research-documented ways to decrease excess mortality, especially among the young and poor, based on the results of peer countries with much lower mortality. The article doesn’t mention the rise in obesity due to the Standard American Diet of processed food. They do mention many potential government programs, all of which would engender serious political opposition.

Sad to say, I don’t see this situation changing. There will probably be many more missing Americans in future years.




America is eating itself to death while enriching the Agro-Industrial Food Complex and the Healthcare-Industrial Complex.

Eat real food and live longer.

The Captain


I find it odd that the authors didn’t mention infant mortality in the paper. For example, the infant mortality rate in the US is almost twice that of Germany and France and 50% higher than in the UK. Later there is a much smaller difference.

For example, for a 25-year old Canadian male, the remaining life expectancy was 52.6 years compared to 52.3 years for males south of the border.



The “American” aspirations that the marketeers and salesmen are peddling leaves large gaps between reality and TV wet dreams.

Social or Economic Rejection → despair → drugs and vices-> sickness and irrational activities-> death

Poor exercise, eating habits ->obesity, immunity and poor health factors ->lifestyle diseases → pharmaceutical treatments and surgeries → death

High instigation from artificial environmental factors → suppressed immunity, mutation and reduced biologic function → poor genetic transfer → infertility and infant mortality

Our system works best when a well informed consumer makes good choices.

Do we need the govt to impose more regs? Or can intelligent adults make good choices?

As a competent national health system is dismissed as “Communism” by a sizable chunk of the population, the other path to more, young, workers, is increased immigration, but that path is also cut off by the same faction of the population.

We are seeing a push to induce more, younger, children, into the workforce, in more types of jobs, for more hours per week, to fill the gap.

A while back, with tongue firmly in cheek, I offered a work requirement for Medicare, for able bodied people, regardless of age, and cutting off SS pension benefits to the able bodied, regardless of age. Those two moves would force millions of currently retired geezers back into the workforce, and prevent millions more people retiring at all, until many of them are in their 80s and too feeble to be of use to the “JCs”. This program would be dressed up with blather about “the dignity of work”, and “personal responsibility”.

A new scheme occurred to me this morning, as I was chugging around my daily 2 mile walk: Change the law so that SS and Medicare benefits are only available to US citizens. This would be very popular with the same faction that opposes both a national health plan, and increased immigration, which has been indoctrinated into thinking immigrants only come to the US to leach off the social programs. Of course, due to the indoctrination about “anchor babies”, program recipients would be required to not only provide their own, certified, birth certificate, but also prove the citizenship of their parents, either by birth certificate or naturalization papers. I suspect millions of current and near retirees would be caught out by the parental citizenship requirement, because they probably don’t have those documents for their parents, and their parents are dead, so cannot be asked where they were born.

Bottom line, some 30-40M voters prevent any reasonable approach to either health care, or immigration. The only alternative to increasing the workforce, would be forcing increasing numbers of children and geezers to work.

offered with more than a touch of sarcasm


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When meritocracy is thrown out the window expertocracy takes over. Who are the experts? The people in power. The people who brought America the food triangle and the low carb diet. I wonder if they are as right about climate as about nutrition. With nutrition at least there are thousands of test subjects, something not available to make double blind climate studies. But then, they didn’t do double blind nutrition studies to dictate the food triangle and the low carb diet. Instead they used the cherry picked seven country study which omitted the 15 that didn’t meet the researcher’s expectations. :roll_eyes:

The Captain

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Shiny-land doesn’t have “expertocracy”. “Expertocracy” implies fact based policy. That doesn’t happen here. Shiny-land is ruled by whoever has the loudest bullhorn.


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I would never advocate for even MORE government control. Unfortunately, I’m not so sure the average “adult” can optimize on the correct choices given social pressures in the home through social media, TV advertisements and junk content on the internet, combined with the external market offerings at restaurants, etc.

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Whose responsibility is that if not his own? Government should not aim to optimise, just to avoid the really bad. Law and order?

The Captain


Not often you’re right on matters of nutrition…and you’re wrong again. Quite apart from the fact that it’s generally the recommendations to follow a low fat diet that’s link with the food pyramid and, with true historical revisionism, blamed for the obesity epidemic.

Thing you’ve gotten wrong here is that Ancel Keys’s Seven Nations Study used, in fact Seven Nations. Not cherry picked data from a different statistical analysis by two different authors. Wikipedia was repeating this myth at one time and I’ve oftentimes wondered about the source. I think the journalist most responsible for this myth that won’t die down is Gary Taubes…a man well recognised as being economical with facts and accuracy when pushing his low carb agenda. Where he got the idea from I can’t imagine but I stuck out as a glaringly obvious misrepresentation in his Good Calories Bad Calories door stop.

Obligatory links…

and for an easier read…

NEWS: Top Experts Come Together to Address Nutrition Myths.

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Although obesity isn’t mentioned specifically…and full disclosure, I was getting a bit punchy before I was halfway through, so there might’ve been a mention …but metabolic disease was listed so I think this could well be inferred as being secondary to that.

For sure, I’m feeling as pessimistic as you, Wendy, about the future as, just looking around, I see younger and younger kids who’re distinctly podgey. I always called childhood dental caries the gift that keeps on giving but I think obesity and its sequelae are catching up at breakneck speed.

And, for all us good custodians of our bodies who’ve never smoked, boozed excessively, gotten fat and inflicted preventable disease upon ourselves…we too can be affected by this as the hoofbeats of more and more Clydesdales drown out the quiet clip clop of the Zebras as the healthcare dollar and mindset gets directed to lifestyle diseases.

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Gun deaths need to be included.

We have a problem with, “they all lie support my liar over here”.

He is an ejit.

Do I need to say it? 1980? The liars took over and killed it all as best they could.

Now it is Germany’s turn to be lied to for a few decades.

Lets make this country rich. Give more people a reason to be involved and vested.

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Key question: Is “naturalization” “good enough”, or do we only want “natural born US citizens” in govt? Hmmm…

Recently, a “thought leader” told three members of the US House to “go back where you came from”. One of the people being addressed is indeed an immigrant. The other two were native born USians, so the issue is more complicated…(none of the three being told “go back” is white)



To where would the “Orange” be returned? NOT white…

Just yesterday he mentioned he would “frankly” rather live in France than the hellhole that is the United States.

I support this. I don’t think anyone should have to live in the US if they don’t want to.


Well, government regulations require nutritional information that allow adult me (maybe intelligent, maybe not) to make what I think are good choices.

You can’t trust food labels. Low salt soups are more often than not loaded with salt. I’ve seen cauliflower snacks (sounds healthy) with more fat than a congressional bill.

Some regulations are actually quite helpful.

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People following him feel so free.


Interesting article in Nature. Somewhat understandable