On May 23, 2025 a Boston University School of Public Health (BUSPH) led study revealed that there were over 1.5 million “missing Americans” in 2022 and 2023, deaths that would have been averted if US mortality rates matched those of peer countries. Excess US deaths have been increasing for decades, with working-age adults disproportionately affected, and this trend continued during and after the pandemic. 

The study published in JAMA Health Forum refers to these excess deaths as “missing Americans” because these deaths reflect people who would still be alive if US mortality rates were equal to the average mortality rate in other high-income countries. 

The findings reveal a continuing and worrying trend in worsening US mortality compared to other wealthy nations over the last four decades. While excess deaths per year peaked at the height of the COVID-19 pandemic in 2021, excess deaths in 2023 still far exceeded prepandemic levels in 2019 and closely matched the rising pre-pandemic trend.

After rising steadily since 1980, excess US deaths reached 1,098,808 in 2021, before dropping to 820,396 in 2022 and 705,331 in 2023, after the acute phase of the pandemic. However, the 2023 figure was still tens of thousands of deaths higher than the 2019 total of 631,247 missing Americans.

The COVID-19 pandemic sharply exacerbated the rise in US deaths in 2020 and 2021, more so than in other countries, and with long-lasting consequences that continue to be realized. But the persistent disparity in US mortality in comparison to its peers is largely driven by crises that began long before the pandemic. 

“The 700,000 excess American deaths in 2023 is exactly what you’d predict based on prior rising trends, even if there had never been a pandemic,” said study coauthor Dr. Elizabeth Wrigley-Field, associate professor of sociology at the University of Minnesota. “These deaths are driven by long-running crises in drug overdose, gun violence, car collisions, and preventable cardiometabolic deaths.”

Future research is needed to pinpoint specific causes of the US’ disparity in mortality rates, but the researchers say the nation should look to the policies of its peer countries for insight into reducing health inequities and improving population health outcomes.