Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2025.0155 Dr. Irene Papanicolas et al.
Points
- From 2009 to 2019, avoidable mortality increased across all US states by a median of 29 deaths per 100,000, while it decreased in most high-income countries by a median of 14.4 deaths.
- The disparity in avoidable mortality among US states widened over time, whereas comparator countries showed a narrowing of differences, indicating growing inequality in health outcomes within the United States.
- During the COVID-19 pandemic, avoidable mortality rose significantly in both US states and comparator countries, with the most significant increases occurring in regions that already had high baseline mortality rates.
- Healthcare spending was strongly linked to lower avoidable mortality in comparator countries, but no such association was found across US states, suggesting inefficiencies in US health spending.
- These findings emphasize the need for systemic reforms in US public health and medical care delivery, as rising mortality rates contrast sharply with improvements seen in peer nations.
Summary
This retrospective, population-based study compares trends in avoidable mortality between 50 US states (including Washington, DC) and 40 high-income countries from 2009 to 2021. Avoidable mortality, which includes both preventable deaths (related to public health and prevention) and treatable deaths (linked to timely medical care), was assessed in individuals aged 0-74 years. The results show a concerning increase in avoidable mortality across all US states during this period, with a median increase of 29.0 deaths per 100,000 people in 2019 (IQR: 20.1–44.2), compared to a decrease in avoidable mortality in most comparator countries, which saw a median reduction of 14.4 deaths (IQR: -28.4 to -8.0).
The variation in avoidable mortality was also more pronounced in US states, increasing from a median of 251.1 (IQR: 228.4–280.4) deaths per 100,000 in 2009 to 282.8 (IQR: 249.1–329.5) in 2019. In contrast, comparator countries experienced a narrowing in this disparity. During the COVID-19 pandemic (2019–2021), avoidable mortality increased for all US states (median: 101.5 deaths per 100,000, IQR: 64.7–143.1) as well as for comparator countries (median: 25.8, IQR: 9.1–117.7). States and countries with the highest baseline levels of avoidable mortality showed the greatest increase in deaths during the pandemic (Pearson ρ = 0.86; P < 0.001).
The study also found that health spending had a significant negative association with avoidable mortality in comparator countries (Pearson ρ = −0.7; P < 0.001), but no significant association was found within US states (Pearson ρ = −0.12; P = 0.41). These findings suggest that while increased healthcare spending is linked to better health outcomes in other countries, the same is not true across US states, pointing to systemic factors affecting the efficiency of health spending in the US.
Link to the article: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2831735
References Papanicolas, I., Niksch, M., & Figueroa, J. F. (2025). Avoidable mortality across us states and high-income countries. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2025.0155
