U.S. Life Expectancy Ranks 38th Worldwide as Study Finds Chronic Disease Deaths Are Driving the Gap

Americans are dying younger than people in dozens of other wealthy countries, and a new study says the usual explanation, drug overdoses and suicides, only tells part of the story.

The research, led by Dr. Steven H. Woolf of Virginia Commonwealth University's School of Medicine and published in the Milbank Quarterly, examined U.S. mortality data from 1999 through 2023 and compared it against 16 other high-income countries. The data came from the United Nations, the U.S. Mortality Database, the CDC, and the Organization for Economic Co-operation and Development.

The headline number: as of 2023, U.S. life expectancy ranked 38th among countries with populations over 1 million, according to the study. Back in 1980, only 13 countries beat the U.S. on that measure, according to Nautilus. Residents of 60 other countries now have a lower risk of dying before age 40 than Americans do.

The Numbers Get Worse By Age Group

Young adults, ages 25 to 44, got hit hardest. All-cause mortality in that group rose 71.2% between 2010 and 2021, the study found. Drug overdoses drove a big chunk of that, but so did early-onset chronic disease: hypertensive disease, endocrine and metabolic disorders, and alcoholic liver disease.

Those aren't diseases of old age. They're showing up in people in their 20s and 30s, and researchers say that's new.

Middle-aged adults saw similar patterns, plus rising deaths from nervous system and genitourinary diseases. COVID-19 became the third-leading cause of death for this group in 2020, according to the Milbank Quarterly article, and mortality from it nearly doubled in 2021, despite vaccines being widely available by then. Older adults had the highest COVID death rates of any age group and also saw rising deaths from neurologic diseases and metabolic disorders.

Since 2010, the widening gap between U.S. and international mortality has been driven by circulatory disease, respiratory illness, nervous system disease, metabolic disorders and external causes, the study found.

What's Actually Causing This

Woolf lists the usual suspects: the opioid epidemic, easy access to firearms, and a food environment that makes obesity the default, according to Nautilus. But he argues those are symptoms, not the disease. His bigger claim is that America's health disadvantage is systemic, tied to a fractured healthcare system, high poverty rates, and a regulatory environment he describes as looser on pollution and consumer product safety than peer nations.

Woolf's analysis also looked at state-level life expectancy from 1941 through 2022 alongside gubernatorial party control, and compared state outcomes to countries with similar life expectancy, according to the Milbank Quarterly. Correlation between a state's political leadership and its mortality rate doesn't establish that party control causes the outcome. States vary enormously in poverty rates, rural hospital access, industrial makeup, and population age regardless of who's governor.

Mónika López Anuarbe, a health economist at Connecticut College, told Newsweek the findings point to long-standing failures in what she called the "iron triangle" of American healthcare: cost, access, and quality, where improving one often means sacrificing another.

That's a fair diagnosis as far as it goes. Emergency rooms full of uninsured patients with uncontrolled blood pressure, and rural counties without a single cardiologist within an hour's drive, are real problems that better insurance design and more competition among providers could actually fix.

But there's a limit to how much of this is a system problem versus a behavior problem. Alcoholic liver disease, metabolic disorders tied to diet, and drug overdoses are not things an insurance card cures on its own. A country can have universal coverage and still have rising rates of liver failure if people are drinking more, and it can have world-class hospitals and still see hypertension climb if nobody's managing their diet. The study's own list of "proximate causes"—obesity, opioids, guns—is largely a list of individual and cultural choices, even if Woolf frames the deeper causes as structural.

Neither Newsweek's coverage nor Nautilus's dug into how much of the increase traces to changes in diagnostic coding or reporting practices over the 24-year study window, a common caveat in long-run mortality comparisons. That's not evidence the trend is fake, but it's a gap in both write-ups worth flagging.

What Happens Next

Woolf's team frames this as solvable, pointing to the fact that other wealthy nations have outperformed the U.S. for decades using different policy mixes, according to Nautilus. No federal legislation has been proposed in direct response to this specific study as of this writing. The open question is whether Washington treats a 71.2% mortality spike among 25-to-44-year-olds as a five-alarm fire or as one more statistic in a report nobody outside public health circles will read.