Far Fewer Kids Would Be Dead If U.S. Was on Par With Europe

Over the past 2 decades alone, hundreds of thousands of children and teens have paid with their lives for the way the U.S. lags behind other high-income countries in health matters, a cross-sectional study showed.

From 1999 to 2019, the U.S. had 413,948 more deaths among kids age 19 and under than expected based on the average among 16 comparable nations, Steven Woolf, MD, MPH, and Derek Chapman, PhD, both of Virginia Commonwealth University in Richmond, reported in JAMA Pediatrics.

“We found that approximately 20,000 deaths among American children and teens would be avoided each year if our country had the average mortality rate that exists in peer countries,” Woolf told MedPage Today.

Infants accounted for the majority of these excess deaths — 56.6% — “reflecting disproportionately high U.S. infant mortality rates,” the researchers wrote. Still, older children and teens saw particular increases in mortality in more recent years.

“The literature documents a long-standing health disadvantage in the U.S. relative to other high-income countries, with excess deaths due in part to disproportionately high mortality rates,” they wrote. However, “[f]ew studies have quantified the number of excess deaths that have occurred among U.S. infants, children, and adolescents, and none based on mortality data from recent years.”

Mortality rates among U.S. youths were higher overall than in comparison countries, but the gap widened with increased rates among those ages 10 to 19 years between 2013 and 2021, at the same time as the median mortality rate in comparison countries decreased.

In 2019, for instance, 15 children ages 10-14 died per 100,000 in the U.S. compared with about 8 per 100,000 in the other countries. For those ages 15-19, the gap was about 50 versus around 25 per 100,000. After 2019, a “pronounced increase” in mortality in the older U.S. teen group shot that rate up to over 60 per 100,000, whereas no such change was observed in most comparison countries.

“Two issues that deserve special emphasis are access to firearms, the leading cause of death in U.S. children, and mental health, given the alarming increase in suicides,” Woolf noted.

The researchers also noted that most deaths in the 10-19 age group were among males (61.4%).

For their study, Woolf and Chapman used U.S. population data from the CDC, along with mortality data for the U.S. and comparison countries from the Human Mortality Database. Excess deaths were calculated for each age group and year by multiplying the difference between U.S. mortality rates and the median mortality rate of 16 comparison countries by the U.S. population count for the respective year.

The 16 comparison countries were Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, and the United Kingdom.

Youths ages 1 to 4 years accounted for 7.5% of the excess deaths. Those 5 to 9 years accounted for 3.9%; 10 to 14 years, 5.8%; and 15 to 19 years, 26.2%. The proportion of excess deaths at 10 to 19 years of age increased over the last decade, from 27.5% in 2009 to 35.8% in 2019.

Limitations of the study included the reliance on data from a select group of comparison countries as well as the inability to disaggregate Human Mortality Database estimates by race and ethnicity or by cause of death, Woolf and Chapman noted.

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