Recent Excess Mortality in Young Adults Save

JAMA has published a University of Minnesota cross-sectional study showing early adult (ages 25-44) mortality in the U.S. has risen substantially between 2011 to 2019 and 2020 to 2023. The largest portion of 2023 excess mortality was driven by drug poisoning, but many other external and natural causes exceeded what prior trends would have projected.

In the last decade mortality rates have either stayed the same or worsened in US population studies, with many attributing the decline to the opioid epidemic and the COVID-19 pandemic.

Researchers analyzed more than 3 million adult deaths aged 25-44 years from 1999 to 2023.  Early adult excess mortality was 34.6% higher than expected in 2019 and then further accelerated during the COVID-19 pandemic. In 2021, all-cause excess mortality was nearly 3 times what it had been in 2019 (116.2 vs 41.7 deaths per 100 000 population). In 2023, excess mortality showed a relative decrease down to 79.1 deaths per 100 000 population.  In 2023 early adult mortality was 70.0% higher in 2023 than it would have been had pre-2011 trends continued. 

The 5 causes of death that collectively accounted for almost three-quarters of the early adult excess mortality in 2023 were:

• drug poisoning (31.8% of excess mortality), 
• residual natural-cause category (16.0%), 
• transport-related deaths (14.1%), 
• alcohol-related deaths (8.5%), 
• homicide (8.2%). Additionally, the combined contribution of cardiometabolic conditions, including circulatory and endocrine, metabolic, and nutritional, was substantial (9.2%)

Policy solutions are needed to address increasing mortality among early adults in specific areas (eg, opioid use, alcohol consumption, traffic safety, dietary risks).