• Posted May 12, 2026

What's Fueling The High U.S. Death Rate? It Might Not Be What You Think

The United States has a higher death rate than other wealthy nations — but not for the reason experts have suspected, a new study says.

Some have thought that an increase in substance-related deaths and suicide – so-called “deaths of despair” – has been boosting the U.S. death rate and causing life expectancy to sag.

But a couple of well-known reasons better explain why the United States lags other high-income nations in dying before one’s time, researchers reported May 8 in JAMA Network Open.

Heart disease and obesity-related health problems accounted for more than half (52%) of more than 900,000 excess deaths that occurred in the United States in 2022 compared to other wealthy countries, researchers found.

“Examining the stagnation in U.S. life expectancy that began in 2010 usually focuses on drug overdoses, alcohol-related deaths and suicide, known as ‘deaths of despair,’ ” said senior researcher Andrew Stokes, an associate professor of global health at Boston University.

”One dramatic finding from this study is that on an absolute scale, cardiometabolic diseases are key contributors to the increase in US death rates,” Stokes said in a news release. “If there was one thing we could address on a population scale, tackling cardiometabolic diseases would substantially reduce the US mortality gap with other wealthy nations.”

For the study, researchers analyzed more than 63.5 million deaths that occurred in the United States from 1999 to 2022, tracking their main causes and comparing them to rates in other wealthy nations.

Researchers estimated that of those deaths, nearly 12.7 million could have been avoided if the U.S. had rates of illness and death similar to those of its peer nations. Here's what else they found:

• Heart diseases accounted for 40% of all excess deaths, with another 13% linked to diabetes, kidney and metabolic conditions. Alzheimer’s disease, dementia, and other mental and neurological disorders accounted for another 20%.

• By comparison, about 14% of excess deaths were due to drug use, 3% to alcohol and 1% to suicide.

• Deaths of despair rose during the study period, with numbers spiking from 2013 as the U.S. opioid epidemic began with overprescription of painkillers. Overall, there was an increase of nearly 137,000 excess deaths annually due to drug use, alcohol and suicide.

• Despite the dramatic increase in deaths of despair, heart disease has continued to be the main cause of early and unnecessary death and of excess U.S. deaths nearly every year from 1999 to 2022.

• In 2022, excess deaths from drug use were nearly 7.5 times higher in the United States than in other nations but accounted for only 10% of its excess deaths.

• On the other hand, heart diseases were only 63% higher in the United States compared to its peers but accounted for 40% of excess deaths that year.

These heart-related deaths might be driven by a lack of preventive care when it comes to heart health in the United States, said Dr. Neil Shah, a cardiologist at Northwell Health in Great Neck, New York.

“We're seeing a lot of these patients when they're at a point where they've had downstream effects, whether that be coronary disease, any type of cardiovascular disease, heart failure, stroke, chronic kidney disease,” Shah said. “They're touching healthcare well beyond the point where prevention could have made a meaningful difference.”

He reflected, briefly, on what to do about it.

“In order to tackle this, I think as a country, from a policy standpoint, we need to figure out how we are going to get patients into preventive care and preventive screening, so that we can use the medications and the counseling that truly make a difference early on to prevent these later cardiovascular outcomes,” Shah said. “I think that's the most important step."

The study found that the United States did outperform other wealthy countries in a couple of categories, suffering fewer excess deaths in 2022 for cancers (excluding lung cancer) and influenza. 

Stokes attributed this to advances in U.S. medicine.

“We’ve come a long way with medical innovations to screen and treat cancers,” he said.

At the same time, the United States cannot afford to overlook the dramatic increase in deaths of despair, given that combined they contributed to 18% of excess deaths, said Dr. Xavier Jimenez, director of consultation psychiatry, addiction medicine and chronic pain at Northwell Long Island Jewish Medical Center in Queens, New York.

“... Behavioral health concerns that go unaddressed catch up with individuals and contribute to an enormous slice of mortality via overdoses, impulsive behaviors, suicide, violence, accidents,” he said.

"COVID-19 really only jet fueled the despair that was already being experienced even before that pandemic," Jimenez added. "If you remember, we had opioid crises, we had political shifts, economic recessions, and then COVID-19 came and isolated individuals, reduced access to care, created enormous burdens and stress, not to mention the physical effects of COVID-19."

He said "it only makes sense" that during and right after the pandemic, COVID was contributing to the despair that was already being felt and accelerated by these processes.

"It even shaped a whole generation of younger adults now who are still dealing with the ramifications of COVID-19," Jimenez added.

More information

The Peterson/KFF Health System Tracker has more on U.S. death rates compared to other countries.

SOURCES: Boston University, news release, May 8, 2026; Dr. Neil Shah, cardiologist, Northwell Health, Great Neck, New York; Dr. Xavier Jimenez, director of consultation psychiatry, addiction medicine and chronic pain, Northwell Long Island Jewish Medical Center, Queens, New York; JAMA Network Open, May 8, 2026