Youth mortality rate widens between US, peer countries, with most deaths among infants

Key takeaways:

• Excess deaths at age 10 to 19 years increased between 2009 (27.5%) to 2019 (35.8%).
• More than half of the deaths involved infants, reflecting disproportionately high U.S. infant mortality rates.

The mortality rate for youths in the United States increased in the last decade compared with peer countries, according to a study published in JAMA Pediatrics.

Steven H. Woolf, MD, MPH, distinguished chair in population health and health equity at the Virginia Commonwealth University School of Medicine, told Healio that his team has studied the U.S. health disadvantage “for years.”

“The U.S. has higher mortality rates than in other high-income countries, and we’ve studied how this affects young and middle-aged adults,” Woolf said. “Few studies have examined how this disparity affects U.S. children and teens.”

Woolf and co-author Derek A. Chapman, PhD, studied U.S. population data from the CDC and mortality data for the years 1999 through 2019, and 2020 to 2022 when available, from the Human Mortality Database for the U.S. and 16 peer countries: Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the U.K. They also pulled age-specific mortality rates for populations aged younger than 1 year and aged 1 to 4, 5 to 9, 10 to 14 and 15 to 19 years. They then calculated excess deaths through indirect standardization of mortality.

“Put simply, we calculate how many deaths would be averted if American youth experienced the average mortality rate that exists in peer countries,” Woolf said.

The researchers found that between 1999 and 2019, 413,948 excess deaths occurred among U.S. youth aged 0 to 19 years, averaging 19,712 deaths per year. Woolf and Chapman found that mortality rates among youth in the U.S. were higher than in the 16 comparison countries, with increasing mortality rates among those aged 10 to 19 years in the U.S. between 2013 and 2021, whereas the median mortality rate in comparison countries decreased, widening the mortality gap.

Infants accounted for most of the excess deaths between 1999 and 2019 at 56.6%. This was followed by 26.2% of teenagers aged 15 to 19 years, 7.5% of children aged 1 to 4 years, 5.8% of those aged 10 to 14 years and 3.9% of children aged 5 to 9 years.

Further, the proportion of excess deaths between ages 10 to 19 years increased over the decade between 2009 and 2019 (27.5% vs. 35.8%), and 61.4% of these excess deaths were among male individuals.

“We were surprised by the scale of the disadvantage,” Woolf said. “We found that approximately 20,000 deaths among American children and teens would be avoided each year if our country had the average mortality rate that exists in peer countries.”

Woolf said physicians must place a “special emphasis” on child injuries regarding firearms, — the leading cause of death in U.S. children — and mental health, given the alarming increase in suicides.

“We know about obvious causes like the prevalence of guns in our society and the mental health crisis affecting U.S. youth, but we need more research upstream on the root causes,” Woolf said. “What is precipitating violence and conflict? What factors are at the heart of the psychological distress American youth are experiencing? There are many theories, but rigorous research is needed.”