The United States spends more on healthcare than almost any other wealthy nation. Yet excess deaths in the US have been rising for over two decades. A major study published in JAMA Network Open in 2026 puts a number on the problem. It analysed 63.5 million American deaths from 1999 to 2022, comparing outcomes against 17 other high-income countries. The findings are sobering.

The researchers found the US experienced roughly 12.7 million more deaths than expected over that period. That is what would have been avoided had Americans died at the same rates as peers in Australia, Canada, France, Germany, Japan, and the United Kingdom, among others.

The Growing Scale of Excess US Deaths

The annual gap has widened considerably. In 1999, there were around 346,000 excess US deaths. By 2022, that figure had climbed to over 905,000. Americans were dying at a rate 1.38 times higher than people in comparable countries.

The US had access to the same advanced medical technology as those nations. The gap was not about equipment or surgical skill. It reflected something deeper about the conditions shaping everyday life and health.

Heart Disease and Metabolic Conditions

The single biggest driver of excess US deaths, year after year, is circulatory disease. This category covers heart disease, hypertension, and stroke. In 2022, circulatory diseases accounted for around 358,000 excess deaths. That is roughly 40% of the entire annual gap.

From 1999 to 2009, this number was actually falling. Then around 2009, progress stalled and reversed. By 2019, excess circulatory deaths were rising by roughly 15,000 each year. Among adults aged 45 to 64, the rise began as early as 2001. That is a full decade earlier than in older age groups. Researchers point to rising obesity rates among American adults as a key factor.

Diabetes, kidney disease, and metabolic conditions tell a similar story. These caused death at a rate 2.25 times higher in the US than in peer countries in 2022. They accounted for 13% of excess deaths. Together, circulatory and metabolic conditions made up more than half of all excess US deaths that year.

Excess US Deaths Linked to Drug Poisonings and Alcohol

One of the most striking findings involves drug poisonings, alcohol-related causes, and suicide. In 1999, the US was broadly in line with peer nations on these three causes. By 2022, they accounted for 131,000 excess deaths per year.

Drug poisoning deaths alone were 7.48 times higher in the US than in comparable countries. The rise accelerated sharply after 2013. Researchers link this directly to the spread of fentanyl in the US drug supply. These deaths are especially significant because they tend to strike younger people. Among those aged 25 to 44, drug poisonings, alcohol, and suicide accounted for close to half of all excess US deaths in 2022. In terms of years of life lost, these causes ranked second only to circulatory disease.

Prevention matters most here. The evidence is clear that early awareness and strong community support structures are far more effective than responding after the damage is done.

What the Pandemic Added

The COVID-19 years brought the sharpest short-term increases. In 2020 and 2021, excess US deaths surged past one million annually. COVID-19 directly accounted for around 19% and 23% of those excess deaths in each year.

The pandemic also worsened pre-existing trends. Excess deaths from circulatory disease, metabolic conditions, and drug-related causes all increased beyond what pre-pandemic trends would have predicted. By 2022, the direct COVID-19 contribution had eased. Other causes, however, had not returned to where they had been before.

Why Excess US Deaths Keep Rising

These patterns reflect differences in social, economic, and policy environments. Researchers have linked rising drug-related deaths and cardiovascular mortality in the US to economic disruption. The decline of manufacturing employment and worsening opportunities for workers without university degrees are among the factors studied. Regions with weaker safety net protections show higher and worsening mortality over time.

The study concludes that many of these excess US deaths could be reduced by adopting policies that have worked in other wealthy nations. International comparisons are useful because they reveal health gaps that are invisible when we only look within a single country. The countries performing better are not doing so by accident.

What Communities Can Do

The conditions that shorten lives most in the United States are often preventable. Cardiovascular risk factors such as raised blood pressure, elevated blood sugar, and excess weight respond to sustained lifestyle changes and regular medical attention.

The growing number of deaths linked to substances underscores the need for early education, honest conversations, and community-level support. Waiting until a problem has taken hold is far less effective than building the awareness and protective conditions that prevent it from developing in the first place.

For policymakers and advocates, this data points in a clear direction. The gap between the US and its peers is wide, but it is not fixed.

Source: jamanetwork