Andrew Stokes

NEW PAPER: "Evolution of the US nonmetropolitan mortality disadvantage by sex, state, and year, 1999‐2019" in @jruralhealth.bsky.social w/Associates Irma Elo & Samuel Preston @eugeniopaglino.bsky.social K Hempstead @astokespop.bsky.social
doi.org/10.1111/jrh....
pmc.ncbi.nlm.nih.gov/articles/PMC...

Cardiovascular Disease and Diabetes Are Driving the Increase in US Excess Mortality—and Adults Without College Degrees Are Bearing Most of the Burden About 525,000 more deaths occurred among US adults in 2023 than would be expected had pre-2010 mortality trends continued. More than 90 percent of these deaths occurred among individuals without a bac...

This work was a team effort—grateful to lead author @eugeniopaglino.bsky.social and coauthor @wrigleyfield.bsky.social

Coverage via @busph.bsky.social

www.bu.edu/sph/news/art...

Education structures exposure to risk.

Adults without a BA are more likely to work unstable jobs, live in areas without access to healthy food, and face financial and logistical barriers to medical care.

These conditions increase the risk of chronic disease and premature death.

Adults without a BA accounted for over 260,000 excess deaths from circulatory diseases in 2023.

Diabetes was another key contributor.

Among men without a BA, nearly 1 in 3 excess deaths were from drug poisonings or other external causes.

Among adults without a BA, mortality in 2023 was 26% higher than expected.

For college graduates, it was 8% higher.

This divergence began before the pandemic, widened sharply during it, and persisted even after COVID deaths declined

Diverging Mortality Trends by Educational Attainment in the US This cross-sectional study examines trends in US mortality rates by sex and educational attainment before, during, and after the COVID-19 pandemic.

The U.S. once saw steady declines in mortality—but progress stalled around 2010.

New research: In 2023 alone, there were 525,505 more deaths than expected had pre-2010 trends continued.

91% were among adults without a BA degree. Most were due to CVD and diabetes.

jamanetwork.com/journals/jam...

Thanks to The Oklahoman (www.oklahoman.com) for running my opinions on the new budget and impacts on Alzheimer's research (bit.ly/4mZXrg7) and public health progress for all of us. #PublicHealth #EndAlzheimers #Epidemiology #ScienceHomecoming

Excess US Deaths Before, During, and After the COVID-19 Pandemic This cohort study examines trends in excess deaths in the US before, during, and after the COVID-19 pandemic.

For 40 years, Americans have lived shorter lives than people in other rich countries.

For 10 years, that's been rapidly getting worse.

New research: in 2022-2023, there were 1.5 million "missing Americans," who died--but wouldn't have, if America didn't have such uniquely high death rates.

Here we have calculated the number of excess deaths attributable to the US mortality disadvantage. This is based on estimates of the number of US deaths that would have been expected each year had the US population experienced the age-specific mortality rates of other wealthy nations.

US Excess Deaths Continued to Rise Even After the COVID-19 Pandemic 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 de...

This work was a team effort—grateful to lead author Jacob Bor and coauthors Rafeya Raquib, Elizabeth Wrigley-Field, Steffie Woolhandler & David Himmelstein. (5/5)

Coverage via @busph.bsky.social

www.bu.edu/sph/news/art...

#MissingAmericans #ExcessDeaths #HealthPolicy @jama.com

The US mortality crisis is decades in the making—shaped by policies that fostered car-centric cities, fragmented health care, weak safety nets, and poor nutrition. These systemic failures cost lives every day—and reversing course will require bold, structural change. (4/5)

In 2023, 46% of all US deaths under age 65 were avoidable. That’s nearly 1 in 2 deaths in working-age adults—driven by overdoses, gun violence, car crashes, and chronic disease, rooted in policy failures and structural neglect. (3/5)

Since 1980, the US has accumulated nearly 15 million “missing Americans”—lives lost because our death rates remain far higher than in other wealthy nations. This crisis began long before COVID and shows no sign of slowing. (2/5)

Excess US Deaths Before, During, and After the COVID-19 Pandemic This cohort study examines trends in excess deaths in the US before, during, and after the COVID-19 pandemic.

New study with @jacob-bor.bsky.social @wrigleyfield.bsky.social & colleagues estimates that US saw 705,331 excess deaths in 2023—a number in line w/ rising pre-pandemic trend. Over 1.5 million deaths could’ve been averted in 2022–23 if US mortality matched peer nations. 🧵 (1/5)

tinyurl.com/569pr9ty

Excess US Deaths Before, During, and After the COVID-19 Pandemic This cohort study examines trends in excess deaths in the US before, during, and after the COVID-19 pandemic.

Excess deaths in the US vs other high-income countries.
Coming down relative to prior US data but still the outlier
jamanetwork.com/journals/jam...

The biggest project I've worked on for the last chunk of years was just published. It asks, how big are US Black-white lifespan differences?

This might seem like a narrow question. I hope to convince you by the end that there are answers you didn't anticipate. And I hope some of them will move you.

Association between Wealth and Mortality in the United States and Europe | NEJM Amid growing wealth disparity, we have little information on how health among older Americans compares with that among older Europeans across the distribution of wealth. We performed a longitudinal...

A blockbuster study from Irene Papanicolas and colleagues linking wealth to mortality.
- At every US wealth level., mortality rates were higher than Europe's
- The wealthiest Americans have a survival rate similar to the poorest northern/western Europeans
www.nejm.org/doi/full/10....

Excess mortality rates of U.S. Americans age 25-44 (relative to 1999-2010 baseline) by cause of death from @wrigleyfield.bsky.social and co-authors

from new article here: jamanetwork.com/journals/jam...

Thank you for writing on this study. We look forward to your insights.

Mortality Trends Among Early Adults in the United States, 1999-2023 This cross-sectional study examines trends in mortality rates among adults aged 25 to 44 years across the pre–COVID-19 pandemic, pandemic, and postpandemic periods.

An important new study from @wrigleyfield.bsky.social, @astokespop.bsky.social and colleagues documenting high levels of excess mortality in adults ages 25-44, including from drug poisonings, transport-related deaths and homicides.
jamanetwork.com/journals/jam...

1/ How should public health think about new GLP-1 drugs like Ozempic? Do pharmaceutical solutions undermine public health prevention efforts?

In @milbankfund.bsky.social, Neil Mehta & I consider what new anti-obesity drugs might mean for population health.

🔗 www.milbank.org/quarterly/op...

A huge thanks to lead author @wrigleyfield.bsky.social and study collaborators Rafeya Raquib, Kaitlyn Berry, and Keeley J. Morris for a great collaboration. (6/6)

@minnpop.bsky.social
@busph.bsky.social
@andrewsthurston.bsky.social
@buciss.bsky.social

Addressing this crisis requires comprehensive public health action, including:

✅ Expanding mental health and substance use treatment
✅ Improving road safety policies
✅ Strengthening efforts to prevent chronic diseases
✅ Investing in social and economic policies that support health. (5/6)

📉 Why does this matter? Even as COVID-19 cases decline, excess mortality remains at crisis levels. Our findings suggest that the pandemic exacerbated pre-existing health risks—but the drivers of this crisis were in motion long before 2020. (4/6)

What’s driving excess deaths? While drug overdoses remain a leading cause (31.8%), other causes are also contributing, including transport-related deaths (14.1%), and alcohol-related deaths (8.5%). We also see a concerning rise in deaths linked to cardiovascular and metabolic conditions. (3/6)

📊 Key finding: In 2023, mortality in this age group was 70% higher than expected based on pre-2011 trends. That translates to over 71,000 excess deaths—far beyond pre-pandemic levels. These numbers underscore a persistent and growing public health crisis. (2/6)

Mortality Trends Among Early Adults in the United States, 1999-2023 This cross-sectional study examines trends in mortality rates among adults aged 25 to 44 years across the pre–COVID-19 pandemic, pandemic, and postpandemic periods.

New study with @wrigleyfield.bsky.social & colleagues finds that excess deaths among young U.S. adults have surged since 2011, accelerating during the pandemic and remaining high in 2023. Our research shows that this crisis extends far beyond drug overdoses. 🧵 (1/6)

jamanetwork.com/journals/jam...

U.S. Mortality trends in the young, ages 25-44 years
jamanetwork.com/journals/jam...
Drug overdoses are the leading cause of excess mortality. There were substantial numbers of Covid fatalities in this age group during the peak pandemic

Bar chart showing excess mortality of Americans aged 25-44, in 2011-2023, broken into causes of death. The chart shows a big growth over time, especially from drug deaths, "other natural causes," and transport-related deaths (car collisions), as well as from Covid-19 in 2021.

Line graph showing the relative (proportional) excess mortality of Americans aged 25-44, in 2011-2023, broken into causes of death. The graph shows big growth in "other natural causes," transport deaths (car collisions), alcohol-related deaths, and homicide.

New today:

Death rates for Americans aged 25-44 have been rising since 2010. Their mortality is now 70% higher than it would be had pre-2011 mortality declines continued.

w Rafeya Raquib, Katie Berry, Keeley Morris, & @astokespop.bsky.social

1/

jamanetwork.com/journals/jam...