Rising deaths in early-aged adults suggests ‘possibility of a worsening mortality crisis’

Key takeaways:

• Excess mortality among early adults was 34.6% higher than anticipated in 2019.
• Excess mortality in 2023 for that population was 70% higher than it would have been if mortality trends before 2011 continued.

Mortality among adults aged 25 to 44 years rose significantly between 2011 and 2023 compared with trends in the early 2000s, results from a cross-sectional study showed.

Death rates in this “early adult” population decreased after the core COVID-19 pandemic years but stayed higher than expected compared with pre-pandemic levels, the researchers reported.

Elizabeth Wrigley-Field, PhD, an associate professor at the University of Minnesota, told Healio that one finding which stuck out to her and her colleagues “is the one-two punch that these age groups have seen: first, rising mortality since 2010; then the pandemic, only partially recovered from.”

“In 2023, about half of the excess mortality reflects excess mortality that was there by 2019, and the other half reflects the increased excess deaths that began in 2020,” she added.

According to the researchers, improvements in mortality trends have stalled or reversed since 2010 for many populations in the United States.

“Although these trends have been described, few studies have focused on early adulthood specifically — the period during which many health behaviors are established,” they wrote in a research letter published in JAMA Network Open.

In the cross-sectional analysis, Wrigley-Field and colleagues examined 1999 to 2023 data on midyear population estimates and mortality, retrieved from the U.S. Census Bureau and CDC WONDER database, respectively.

A total of 3,392,364 deaths among Americans aged 25 to 44 years occurred during the study period, while Wrigley-Field and colleagues found that increased mortality trends across many causes of death “produced substantial excess deaths compared with extrapolations of pre-2011 trends.”

They reported an early adult excess mortality rate 34.6% higher than anticipated in 2019 that increased further during the pandemic.

The analysis also showed an excess mortality in 2021 nearly three times higher than what it had been in 2019 (116.2 vs. 41.7 deaths per 100,000).

Excess mortality decreased in 2023, but only to about halfway between its levels in 2019 and 2021 (79.1 deaths per 100,000).

Ultimately, the researchers reported early adult excess mortality 70% higher in 2023 than it would have been had mortality trends prior to 2011 continued.

The top five causes of death that substantially contributed to early adult excess mortality in 2023 included:

• drug poisoning (31.8%);
• residual natural causes (16%);
• transport-related deaths (14.1%);
• alcohol-related deaths (8.5%); and
• homicide (8.2%).

“Individuals might not necessarily be able to reverse those factors, or their consequences, on their own, but public health collectively has been very successful at improving health through policies like tobacco regulation, to name one example,” Wrigley-Field told Healio.

The combination of cardiometabolic conditions, like metabolic, circulatory and endocrine and nutritional conditions, also accounted for 9.2% of excess mortality that year.

The researchers highlighted some study limitations, which included their use of provisional mortality data for 2023 and their assessment of aggregate trends as opposed to subpopulations.

Rises in early adult mortality “can signal population risks that may become more pronounced as these cohorts age,” Wrigley-Field and colleagues explained.

“To me, the cardiometabolic causes of death stand out because these are really a bellwether of population health,” Wrigley-Field noted. “These causes tend to be very responsive to the fundamentals of healthy living: healthy food, exercise, sleep, limited exposure to tobacco and air pollution and limited experience of excessive stress.”

She added that in the context of primary care, “knowing that deaths to those causes have been increasing at these young ages might influence how aggressively to respond to early signs of a poor health trajectory (like pre-diabetes).”