Between 2009 and 2021, avoidable mortality has increased in all 50 states and Washington, D.C. but decreased in peer countries, Brown and Harvard researchers found.
The study, published last month in Journal of the American Medical Association Internal Medicine, compared rates of avoidable mortality in the United States with 40 other high-income countries.
Avoidable mortality includes deaths that can be avoided through “high-quality preventive care, public health (policy) or timely, high-quality access to medical treatment," according to lead study author Irene Papanicolas. Avoidable deaths can be sorted into two categories: preventable mortality, like death by car accident or vaccine-preventable disease, and treatable mortality, like appendicitis or sepsis.
According to the study, the average increase in avoidable deaths in the U.S. was 32.5 deaths per 100,000 people, though this varied by region.
Papanicolas said the findings will help experts begin to understand “which policies confer benefits to health and which ones pose risks to health in certain states.” She expects the study will help experts promote these policies nationwide. Papanicolas is the director of the Center for Health Systems Sustainability in the School of Public Health and a professor of health services, policy and practice.
Researchers analyzed data from the U.S. Centers for Disease Control and Prevention and the World Health Organization, comparing mortality rates by dividing populations into five-year age groups and assessing trends across countries. SPH Research Data Analyst Maecey Niksch, the second author on the study, sorted through 80 million cause-of-death data points using RStudio to determine how many died from avoidable causes.
Among the 40 other countries studied, only Canada, the United Kingdom, Mexico, Turkey, Bulgaria and Australia did not see a decrease in avoidable mortality rates over the 12 years.
In the U.S., avoidable deaths increased due to car accidents, suicides, homicides and overdoses. Deaths from treatable cancers and other medical conditions also rose, though to a lesser extent. Across both the U.S. and comparable countries, avoidable deaths rose during the COVID-19 pandemic from 2019 to 2021.
The U.S. spends more on health care than any other country, yet continues to have growing and comparatively higher rates of avoidable mortality.
“More health care spending doesn’t necessarily confer more value in the health care system,” Niksch said.
This disparity, Papanicolas said, is likely due to “weak public health infrastructure,” as well as the influence of socioeconomic determinants and the high costs of health care.
Despite the quality of health care centers in the nation, Papanicolas said a “broader welfare state” can help “protect people” from factors that can contribute to avoidable mortality.
The researchers found wide variation in avoidable mortality across states in the U.S. For instance, while West Virginia had the highest increase at 99.6 per 100,000 people, New York had the lowest at 4.9 per 100,000 people. All states saw increases in preventable mortality, but only Massachusetts, Maryland and Delaware saw decreases in treatable mortality, according to Papanicolas.
To reverse the trend of increasing avoidable mortality, Papanicolas emphasized the importance of investing in health infrastructure and implementing protective measures, such as improving traffic safety and nutrition.
Jennifer Sacheck, a professor and chair of social and behavioral sciences who was not involved with the study, wrote to The Herald that she was not surprised by the findings. She noted that it was “not possible to control for key variables that might explain some of the findings.”
For example, she “would be curious what the results would look like if obesity rates were able to be controlled for given its impact on many chronic disease conditions,” Sacheck said.
Leah Koritz is a senior staff writer covering science & research. Leah is from Dover, Massachusetts and studies Public Health and Judaic Studies. In her free time, Leah enjoys hiking, watching the Red Sox and playing with her dog, Boba.
