Researchers found excess deaths among early adults had risen sharply by the end of the last decade, surged during the COVID pandemic, and remained high after it eased. Photo by cmannphoto/iStock

Excess Deaths

More Americans Aged 25 to 44 Are Dying Younger. BU Research Helps Explain Why

School of Public Health researcher coleads study that finds sharp increase in excess deaths largely due to drug overdoses, alcohol use, traffic accidents, and homicides

Back in 1850, the odds of hitting a ripe old age were grim: the average American didn’t make it to their 40th birthday. Since then, life expectancy has mostly ticked higher and higher—and today, many Americans can expect to live to almost 80.

But that progress has been stalling in recent years—even falling into reverse. Americans are dying younger—some much younger, according to a new study coled by the Boston University School of Public Health. After comparing mortality trends from the early 2000s with those of today, researchers found what they called “excess deaths” had surged among people aged between 25 and 44. Excess deaths are those above what had been projected for a given period. In an era when we assume each generation will live longer than the one before it, why are so many younger adults dying before their time?

The number one cause, according to the researchers: drug poisoning, or overdoses. Transportation- and alcohol-related deaths were major factors, too, along with homicides and natural causes. The study also noted that cardiometabolic conditions—which can include obesity, heart disease, and diabetes—were significant contributors, leading to 9.4 percent of the excess deaths. The results were published in JAMA Network Open.

“Young adult deaths are, to a large extent, preventable,” says Andrew Stokes, an SPH associate professor of global health. He coled the study with sociologist Elizabeth Wrigley-Field of the University of Minnesota. “There are several major areas where we desperately need policy intervention.”

The researchers analyzed close to 3.4 million deaths from 1999 to 2023. To calculate excess deaths, they first projected death rates for the period using pre-2011 mortality trends, then compared those numbers to actual deaths during the period. Putting the two side by side gave them the excess deaths figure, which they found had rocketed up by the end of the last decade, spiked during COVID, and remained high even after the pandemic eased.

“Early adult mortality was 70 percent higher in 2023 than it would have been had pre-2011 trends continued, reflecting 71,124 excess deaths,” the study concluded. In fact, says Stokes, excess deaths are now trending higher than they were before COVID: “We were expecting a rebound to the pre-pandemic trend, but it’s even worse—it’s accelerated.”

Stokes says this generation of early adults grew up in a time of economic uncertainty and downward mobility compared to their parents. And, he adds, they’ve had to contend with the “expansion of industries that affect public health—processed foods and beverages, prescription drugs and OxyContin, alcohol, combined with this creeping effect of the obesity epidemic.” The rise of cardiometabolic disorders among younger people is, he says, a particularly concerning red flag: “Usually, it takes a lifetime to manifest cardiovascular disease and related mortality.”

While past research has suggested overall life expectancy in America is stumbling, Stokes says that was mostly thought to be impacting midlife and older Americans; this latest paper shows those tentacles are reaching down a generation.

“These are the ages, 25 to 44, in which behaviors become entrenched and life course risks start to develop,” he says. “And if we’re seeing this excess mortality in this generation now, it’s also an indication of what may happen to population health as a whole in decades ahead as this generation ages.”

The research was what Stokes calls a “whole population analysis”—meaning it didn’t dive into how the numbers shifted by race or gender, for example, which is something he’d like to address in future studies. But he says his broader research is showing the importance of education as a factor in shaping health and well-being. “We’re increasingly seeing inequalities across educational divides,” he says, “particularly between those who hold a BA degree or higher versus those with less than a BA.”

In the journal article outlining their new findings, Stokes and his colleagues advocate for policies that will take on some of the causes of excess deaths by curbing alcohol and opioid use, improving nutritional health and traffic safety, and preventing chronic diseases.

“There’s more discussion around regulation of food and beverage companies and ultra-processed foods,” says Stokes. “But a lot of that is still very nascent or aspirational.” President Trump’s controversial pick to head the Department of Health and Human Services, Robert F. Kennedy Jr., is among those who’ve pushed for greater scrutiny of ultra-processed foods.

A mortality demographer, Stokes previously studied excess mortality during the COVID pandemic, tracking coronavirus deaths that fell outside of official tallies. And he points to the lingering impacts of the COVID pandemic on this generation of early adults—not just on their physical health, but also on their mental well-being. He says 25- to 44-year-olds were hit particularly hard by the social dislocation caused by lockdowns—and those effects continue to reverberate.

According to Stokes, many of what he calls the “deaths of despair”—whether from alcohol use or suicide—can be traced back to loneliness. In 2023, the US surgeon general said the country was in the midst of a loneliness epidemic, publishing an advisory that said loneliness and isolation “represent profound threats to our health and well-being.” The advisory cited research that compared loneliness’ impact on mortality to smoking 15 cigarettes a day.

“Reaching out to friends and family, social groups you’ve lost contact with,” says Stokes, “those social connections are very health promoting, and they’re greatly needed in this time.”

This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Robert Wood Johnson Foundation, the National Institute on Aging, and the W.K. Kellogg Foundation.