'Excess deaths' are surging among young adults, study finds. Experts say it's not just drug overdoses. - chof 360 news

Americans are dying in young adulthood at alarming, and rising, rates, according to a new study published in JAMA Network Open. The rate of excess deaths — fatalities beyond the expected number — among people between ages 25 and 44 has nearly tripled since 1999. And while the COVID-19 pandemic and well-documented drug overdose crisis have contributed to the trend, young adults are dying prematurely of other, less obvious causes too.

Here’s what to know — and why it matters for everyone.

What the study found

The problem began in 2011. After holding steady for more than a decade, the number of excess deaths began climbing that year. By 2019 the figure was 34% higher. To the surprise of the study authors, rates of young adult deaths started rising before COVID-19 came to the United States, but the pandemic fanned the flames. Excess mortality for the age group peaked in 2021, at nearly triple the 1999-2010 rate.

COVID-19 led to an uptick of young adult deaths due to respiratory illnesses, but excess deaths from issues exacerbated by the pandemic rose far more sharply. But with the rollout of vaccines and a return to relative normalcy, the trend began to ebb. By 2023 the young adult excess death rate had fallen but was still 70% higher than baseline. A total of 172,785 people between the ages of 25 and 44 died that year. Statistically speaking, more than 71,000 of them shouldn’t have.

The ‘external’ causes killing young adults

Most excess deaths among young adults are due to what researchers call “external causes.” These include drugs, alcohol, transportation, suicide and homicide.

Although annual drug overdose deaths have finally begun to fall, opioids like fentanyl and other drugs are still responsible for the lion’s share of excess deaths among young adults. In 2023 nearly 32% of these deaths were due to overdoses.

Alcohol is contributing too, accounting for more than 8.5% of excess deaths in 2023. Related health problems, including liver disease and alcohol-induced accidents, were responsible for the deaths of 9,763 young adults in 2023. But in 2021, alcohol-related fatalities exceeded the rate scientists would expect by a wider margin than any other cause of death, including drugs. Some experts argue that there is “generational despair that’s giving rise to substance use, but not everyone agrees with that and points to the supply side,” Elizabeth Wrigley-Field, a professor of sociology at the University of Minnesota and study co-author, tells chof360 Life. “Alcohol is not well-regulated [in the U.S.] compared to other wealthy nations, and we need to do more to protect young people against it.”

Cars are also killing young Americans. Transportation led to more than 14% of 2023’s excess deaths, claiming the lives of 9,892 people between 25 and 44. However, Dr. Steven Woolf, a Virginia Commonwealth University professor of family health and population health, thinks there may be hope on the horizon. “My generation became kind of addicted to cars,” he tells chof360 Life. “Younger generations don’t feel like they need a car. That’s a cultural norm that may be shifting, where young people may not feel like that’s so important in their lives.”

Excess deaths because of suicide have risen above expectations but more modestly. Premature homicide deaths, on the other hand, have surged, making up 8.2% of all excess deaths in 2023. “What’s going on in our society that’s creating stress, conflict and rage that makes this kind of injury more prevalent?” asks Woolf. “We see this in other countries too … but it’s the widespread availability of guns in the U.S. that makes those bursts of anger fatal.”

Deadly disease is on the rise too

Natural causes contributed fewer deaths to 2023’s excess than external ones but can’t be overlooked, Andrew Stokes, study co-author and Boston University associate professor of global health, tells chof360 Life. “A lot of the discussions [about young adults’ mortality], rightfully, are around drug overdose deaths and other external causes, which are very important, and yet it’s not only those things” driving the rising deaths, he says. “It’s also due to cardiometabolic causes of death increasing over this time frame.”

Cardiometabolic conditions are a group of health problems related to the heart, blood vessels, obesity and how the body uses energy, which often occur together. According to the new study, cardiometabolic causes of death, taken together, accounted for 9.2% of excess deaths in 2023.

The young adults included in the study lived amid “adverse food environments and unhealthy foods” as well as a booming market of powerful drugs such as fentanyl, notes Stokes. “So there have been a lot of supply-side factors that have made it uniquely dangerous to be these ages at this time,” he says.

Plus, the rise in excess deaths became especially sharp after 2010, amid the recession that began in 2009. Rates of obesity, heart disease and diabetes among young adults have been climbing for a long time. But obesity too began to rise more dramatically in the same timeframe. The pandemic also triggered a recession, leading to more economic hardship and longer, harder work hours for some. Though the new study doesn’t dig into exactly why excess deaths are rising, “a piece I think we don’t always think about is work hours: how that impacts what foods [are] realistic to eat, what kind of socializing is realistic, how much time someone has for exercise,” says Wrigley-Field. “Stress, sleep, food, exercise, air pollution — these are kind of the fundamentals [of health], and these are the causes of death that clearly respond to those fundamentals.”

What can be done

On the individual level, the best thing you can do is go back to those basics: Eat a nutritious diet; get sufficient, good-quality sleep; maintain a healthy weight; exercise regularly; don’t smoke; limit alcohol consumption; and avoid other dangerous substances.

But experts agree that those healthy habits are not as easy to keep up as they sound, when the environment around you doesn’t encourage them. Woolf points at smoking as a blueprint. Americans’ health improved markedly after policies were put in place to make smoking harder to do and less appealing. These efforts flattened the rising curve of lung cancer diagnoses and deaths that likely couldn’t have been achieved simply by continuing to educate people about the dangers of smoking. “What was a game changer was changing systems in our society that made it easier for people to avoid smoking,” Woolf says. “These kinds of system designs help promote the kinds of behavior that are helpful.”

No one should panic, but everyone should pay attention to the findings of the new report, because it means that diseases that once only became deadly in old age are now killing people before they reach middle age, says Woolf. And that includes policymakers. While Woolf appreciates the MAHA — Make America Health Again — movement’s focus on chronic disease, environmental toxins and the low-quality U.S. food supply, he has doubts about current plans to tackle Americans’ poor health. “Our policies in our country that deal with jobs, wages, income insecurity and housing have a huge impact on our health and are probably more important than food additives and other topics that are in vogue to explain the poor health of Americans,” he says.