Youth death rate still higher in US than similar countries, with pandemic bump in older teens

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Young people died of any cause at higher rates than those in 16 other high-income countries from 1999 to 2019, with a steep increase in deaths in youth aged 15 to 19 years during the COVID-19 pandemic, according to a research letter published yesterday in JAMA Pediatrics.

Using data from the US Centers for Disease Control and Prevention (CDC) and the Human Mortality Database, Virginia Commonwealth University researchers compared death rates among US youths aged 0 to 19 years with those in 16 comparison countries, estimated excess deaths for 1999 to 2019, and assessed mortality trends through 2021.

The comparison countries were Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, and the United Kingdom.

"The literature documents a long-standing health disadvantage in the US relative to other high-income countries, with excess deaths due in part to disproportionately high mortality rates," the study authors wrote. "Recent years have seen an increase in youth mortality due to homicide, suicide, and drug overdoses and in all-cause mortality during the COVID-19 pandemic."  

A widening mortality gap 

US youths died at higher rates than their counterparts in all comparison countries. Death rates rose among adolescents aged 10 to 19 years from 2013 to 2021, but the median death rate in the other countries fell, widening the mortality gap. While the United States saw a steep rise in deaths among teens aged 15 to 19 years, most comparison countries did not.

Each year, nearly 20,000 deaths among youths at aged 0 to 19 years would not have occurred had US youths experienced the median mortality rates of 16 comparison countries.

An estimated 413,948 excess deaths occurred in US youth aged 0 to 19 years from 1999 to 2019, for an average of 19,712 annual deaths. Infants made up 56.6% of excess deaths during those years, followed by those aged 15 to 19 years (26.2%), 1 to 4 (7.5%), 10 to 14 (5.8%), and 5 to 9 (3.9%). The percentage of excess deaths among 10- to 19-year-olds rose from 27.5% to 35.8% from 2009 to 2019; young men made up 61.4% of those deaths.

"Each year, nearly 20,000 deaths among youths at aged 0 to 19 years would not have occurred had US youths experienced the median mortality rates of 16 comparison countries," the researchers wrote. "More than half of these deaths involved infants, reflecting disproportionately high US infant mortality rates. These findings are consistent with a 1961-2010 estimate of excess US pediatric deaths." 

The suicide rate among youth aged 10 to 19 years started to rise in 2007, as did murders in 2013 and fatal drug overdoses in 2014. "Easier access to firearms and opioids likely contributed," the authors concluded.

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