{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:59:54Z","timestamp":1790150394147,"version":"4.0.1"},"reference-count":90,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"abstract":"<jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"box\" position=\"anchor\">\n                        <jats:caption>\n                          <jats:title>Policy Points<\/jats:title>\n                        <\/jats:caption>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>US life expectancy is shorter than in other high\u2010income countries and the gap has widened dramatically over time, driven in particular by rising mortality rates that threaten the probability that youth can survive to middle age, or even adulthood.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>Policy priorities to address this crisis include efforts to address the proximal causes of rising mortality, such as poor diet, drug overdoses, problem drinking, homicide, suicide, and chronic diseases such as cardiometabolic, neurologic and genitourinary diseases, among others.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>Meaningful progress in closing the gap with other high\u2010income countries must go beyond proximal causes to address structural factors that systematically compromise the health of Americans, such as deficiencies in the health care system, adverse socioeconomic conditions, threats from the physical and social environment, and public policies that do not prioritize the health and safety of the population or that perpetuate health inequities.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>At a time when political support for such policies is sharply divided in the United States, states are exerting greater power over policies that could improve\u2014or worsen\u2014population health.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>The challenge in the United States in solving the mortality crisis is not a lack of policy solutions but of political will to prioritize population health over competing interests.<\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>US life expectancy is shorter than in other high\u2010income countries, and the gap has widened over time. This article examines the mortality patterns that help explain the widening gap, considers the root causes that might be to blame, and discusses potential policy solutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sources of mortality data included the United Nations Department of Economic and Social Affairs, US Mortality Database, Centers for Disease Control and Prevention, and Organisation for Economic Cooperation and Development. The analysis examined life expectancy and age\u2010specific mortality rates by country, cause\u2010specific US mortality rates from 1999 through 2023, and cause\u2010specific mortality rates in 16 high\u2010income countries for comparison. A literature review examined potential explanations for the US health disadvantage, including the growing role of states and partisan polarization. This was supplemented by an analysis of state\u2010level life expectancy and gubernatorial party affiliation for 1941\u20132022 and a comparison of state life expectancy in 2017\u20132021 with countries reporting similar life expectancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>As of 2023, US life expectancy ranked 38th among countries with a population greater than 1 million, and the populations of 60 countries faced a lower risk of dying before age 40 than did Americans. Causes of death responsible for changes in all\u2010cause mortality varied by age group. Leading contributors among infants and children included sudden unexplained infant deaths and external causes (e.g., transport, homicide, suicide). Young adults (ages 25\u201344) experienced the largest relative increases in all\u2010cause mortality of any age group, including a 71.2% increase between 2010 and 2021, driven by deaths from external causes, notably drug overdoses, and early\u2010onset diseases (e.g., hypertensive disease, endocrine and metabolic disorders, alcoholic liver disease). Middle\u2010aged adults experienced increased mortality from similar causes (hypertensive diseases, endocrine and metabolic disorders, external causes), as well as higher death rates from nervous and genitourinary system diseases. Mortality from COVID\u201019, which emerged in 2020 as the third leading causes of death among middle\u2010aged adults, almost doubled in 2021, despite the availability of vaccines. Older adults experienced increased mortality from neurologic diseases and endocrine and metabolic disorders and the highest mortality rates from COVID\u201019. Since 2010, the gap in all\u2010cause mortality between the United States and 16 high\u2010income countries has been driven by higher death rates from circulatory diseases, external causes, nervous system diseases, respiratory diseases, and endocrine and metabolic disorders. Explanations for the US health disadvantage include proximal causes (e.g., opioid epidemic, access to firearms, the obesogenic food environment, affective disorders), as well as systemic factors such as deficiencies in the health care system, socioneconomic precarity, a lax regulatory environment, and structural racism. State\u2010level life expectancy and mortality rates have increased over time and appear associated with policy and increasingly partisan orientations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The United States faces a mortality crisis that requires attention not only to specific causes of death but also systemic issues that compromise health. That better health outcomes are achievable is demonstrated by the growing list of high\u2010income and middle\u2010income countries that have achieved higher life expectancy than the United States. Policies that would close the gap, which have historically attracted weak political support in the United States and are now being actively opposed at the federal level, can be pursued by states and communities with greater commitments to improving population health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1468-0009.70118","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:01:42Z","timestamp":1790146902000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["US Life Expectancy and Increasing Mortality Rates: An Analysis of the Crisis"],"prefix":"10.1111","author":[{"given":"STEVEN H.","family":"WOOLF","sequence":"first","affiliation":[{"name":"<i>Virginia Commonwealth University School of Medicine<\/i>"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"GDP (webpage).World Bank Group. 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