A Disturbing Trend in Young Adult Deaths
A recent Slate analysis highlights a grim reality: Americans in their 20s, 30s, and 40s are dying at much higher rates than their peers in other wealthy countries. What was a worrying gap when I was in medical school a decade ago is now a chasm. Among Americans aged 25 to 44 (mostly Millennials and older Gen Z), about 62% of deaths are “excess,” meaning nearly two out of three would not occur if the U.S. matched peer-nation mortality. In raw terms, that’s hundreds of thousands of “missing Americans” each year, roughly 700,000 in 2023 alone. These numbers are startling and tragic, and they beg the question: why is it so dangerous to be a young adult in America?
The causes are multiple and complex, and in light of such systemic issues it is all the more pressing to focus on what we can control. We can’t single-handedly rewrite national policy, but we can make choices that move the needle for our own health. I’ll start by clarifying where COVID fits, and doesn’t, in this story, then explore the post-2010 slide (including the rise of loneliness and social disconnection) and how eroding safety nets and increasing system complexity have contributed to the rise. Finally, I’ll focus on the strongest lever you control: a trusted primary care relationship that’s accessible, continuous, and proactive. Let’s begin with the obvious suspect, COVID, then zoom out to the longer trend that started well before 2020.
Not Just COVID: A Decades Long Decline
This downward spiral for young adults appears to have started in the 80s, with a sharp increase in the past 10-15 years. For decades prior to this period, health and longevity for Americans in early adulthood were gradually improving, deaths from illnesses like HIV, certain cancers, heart disease, and even homicide were decreasing year by year. But sometime around 2010, those gains stalled and reversed. Suddenly, other causes of death surged to erase the progress. Drug overdoses (fueled by the opioid crisis, including fentanyl), alcohol-related disease, suicides, liver failure, deadly car crashes, and even illnesses like diabetes and digestive diseases began climbing sharply among people in their 20s, 30s, and 40s. The net effect was that by the late 2010s, young adults were losing the ground on life expectancy that older generations had steadily gained.
This trend became tragically clear in the wake of the pandemic. During 2020–2021, COVID drove up mortality for all adults, young and old. But once the worst of the pandemic passed, older Americans’ death rates largely fell back to normal, whereas younger adults only recovered about half of their spike in deaths. In other words, young adults in the U.S. have settled into a new, higher “normal” death rate post-2021, unlike any other age group. By 2023, Americans aged 25 to 44 were a staggering 2.6 times more likely to die than same-aged individuals in other high-income countries. This is not a temporary blip; it’s a severe and ongoing generational health crisis.
The Loneliness Epidemic and Social Strains
There is no single answer for the recent worsening in this trend, but observers note that the early 2010s were a time of significant social and economic strain for today’s young adults. Many older Millennials entered the workforce during the Great Recession, and by 2010 were grappling with a weak job market and financial instability. Around the same time, the rise of smartphones and social media was transforming how we connect, or fail to, with each other. Researchers have since warned of an “epidemic of loneliness” in modern society, with younger generations reporting high levels of social isolation and disconnection. This loneliness epidemic, combined with economic stressors, can fuel depression, substance abuse, and other health issues. In essence, widespread isolation and mental health struggles have created an environment where preventable deaths became more common. The pandemic further exacerbated these factors and brought mortality figures under much closer scrutiny.
It’s important to note that the causes of America’s young-adult mortality surge are complex and multifaceted. Experts have proposed several overlapping theories to explain why the U.S. does so much worse at keeping people alive into midlife. Some point to economic changes, for instance, the decline of stable blue-collar jobs and deindustrialization, which left many working-class young people with fewer opportunities and stripped of their employer-provided health insurance. Others highlight the eroding social safety net in the U.S. (unemployment benefits, sick leave, affordable housing support, etc.), which is much less generous than in other rich nations. Problems in the health care system are another target: millions lack insurance or face high out-of-pocket costs, leading people to skip needed care. Additionally, America’s lifestyle and policy environment can be perilous, for example, more permissive gun laws drive higher rates of homicide and suicide, and a car-centric culture leads to more deadly accidents. All of which also play a role in excess mortality. All of these factors predate the pandemic and remain ongoing, and together they paint a picture of systemic issues converging on younger Americans.
Eroding Social Support Systems
Many of these problems are outcomes of policy choices made over decades. Starting in the 1980s, the United States took a different course from other wealthy countries in how it supports the well-being of its citizens. Over the past 40+ years, a series of political decisions have systematically eroded the social support system. In this period, we’ve seen:
- Social programs slashed: Funds for public health, education, welfare, and anti-poverty programs were cut back, shrinking the safety nets that help people through hard times.
- Industries deregulated: Rules that once kept various industries in check were loosened, from finance to food and environmental safety, often prioritizing corporate profits over consumer protections.
- Worker protections weakened: Labor unions declined and labor laws relaxed, leading to more job instability, stagnating wages, and fewer negotiated benefits for the average worker.
- Corporate interests prioritized: Government policy increasingly deferred to big corporations: tax cuts for the wealthy and large companies, bailouts for Wall Street, and increased corporate influence on legislation, at the expense of ordinary people.
The result of these long-term trends has been profound. We now have a shredded safety net, skyrocketing inequality, and a healthcare system that can bankrupt you for getting sick. In short, the basic supports that help keep a population healthy: stable jobs with living wages, affordable housing, accessible healthcare, and strong community institutions, have all been hollowed out over time. Millennials and Gen Z are the first generations to have spent their entire lives under this new economic paradigm, one often described as “profit over people.” They came of age in an era of expensive college tuition, gig-based employment, unaffordable housing, and dwindling public services, watching as the unprecedented quickly became precedented and even normalized. These social stressors and economic conditions don’t just strain wallets; they strain bodies and minds. When a young person has to work two jobs to make rent, struggles to pay medical bills, and feels disconnected from their community, it should not come as a surprise when their health suffers. The alarming mortality numbers we’re now seeing among young Americans are in major part the human cost of decades of policy decisions that have systematically undervalued social support.
Taking Your Health Into Your Own Hands
It is easy to feel powerless in the face of such systemic challenges. We can’t fix a broken social system overnight, and most of us can’t single-handedly change national policy. However, there are steps we can take as individuals, families, and communities to protect our well-being in the face of these trends. In fact, when the social and societal systems that are meant to provide for us are falling short, it becomes even more crucial to take whatever aspects of our health we can into our own hands.
One of the most important things you can do is to build a strong support network around your health. This means not only leaning on friends and family, but also having a healthcare provider who knows you and truly has your back. It’s part of the reason why I founded Sana Sana as a direct primary care clinic. I cut out the insurance middleman and re-introduced a more old-fashioned, therapeutic relationship between doctor and patient. In practice, it means longer, more attentive appointments where you can actually talk to me. It means you can call or message me when you’re sick or scared, without jumping through insurance hoops. Decisions about your care are made by you and I together as patient and physician, not by a distant bureaucrat focused on maximizing profit margins. In a healthcare system that often puts paperwork and profits first, at Sana Sana Clinic I am determined to put people first. Always. While direct primary care isn’t a panacea for all the issues of my millennial generation, it is one way you can take back a measure of control. You should not have to navigate these healthcare challenges alone. When you have a trusted doctor-patient partnership, you’re better equipped to stay healthy and catch problems early, an increasingly valuable safeguard when living at a time when our external safety nets can’t always be relied on.
America’s young adult mortality problem is real, and it has deep roots in how our society is structured. Until those larger structures improve, focusing on what we can control becomes essential. Take steps to care for your mental health, seek out community connections to combat loneliness, and don’t hesitate to demand better for your health care. If you’re frustrated with the status quo, consider enrolling with my direct primary care clinic or a similar practice that prioritizes your health over any bottom line. Having a doctor who truly cares in your corner isn’t just comforting, it can be life-saving. Together, by reclaiming a bit of agency over our health, we can strive to beat the odds and live the long, healthy lives that every person deserves.
References
Ahmad, Farida B.; Jodi A. Cisewski; and Robert N. Anderson. “Leading Causes of Death in the US, 2019–2023.” JAMA 332(12): 957–958 (Sep 24, 2024). doi:10.1001/jama.2024.15563. 
Blumenthal, David. Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System—Comparing Performance in 10 Nations. The Commonwealth Fund (Sep 19, 2024).  
Bor, Jacob; Rafeya V. Raquib; Elizabeth Wrigley-Field; Steffie Woolhandler; David U. Himmelstein; and Andrew C. Stokes. “Excess US Deaths Before, During, and After the COVID-19 Pandemic, 1980–2023.” JAMA Health Forum 6(5): e251118 (May 2, 2025). doi:10.1001/jamahealthforum.2025.1118. 
Case, Anne; and Angus Deaton. “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century.” Proceedings of the National Academy of Sciences 112(49): 15078–15083 (2015). 
Gunja, Munira Z.; Evan D. Gumas; Reginald D. Williams II; Michelle M. Doty; Arnav Shah; and Katharine Fields. The Cost of Not Getting Care: Income Disparities in the Affordability of Health Services Across High-Income Countries. The Commonwealth Fund (Nov 16, 2023). 
Naumann, Rebecca B.; Belinda A. West; Vincent Barry; Sarah Matthews; and Robin Lee. “Pedestrian and Overall Road Traffic Crash Deaths — United States and 27 Other High-Income Countries, 2013–2022.” MMWR (Mar 13, 2025). doi:10.15585/mmwr.mm7408a2. 
National Academies of Sciences, Engineering, and Medicine. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press (2021). doi:10.17226/25976.  
National Research Council and Institute of Medicine; Woolf, Steven H., and Laudan Aron (eds.). U.S. Health in International Perspective: Shorter Lives, Poorer Health. Washington, DC: The National Academies Press (2013). doi:10.17226/13497. 
Office of the Surgeon General (U.S. Department of Health and Human Services). Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community. (May 2023).  
Prada, Luis. “American Millennials (and Elder Gen Z) Are Dying Young.” VICE (Aug 22, 2025). 
Wilkins, Joe. “If You’re a Millennial, We Have Bad News About Your Rapidly Impending Death.” Futurism (Aug 21, 2025).  
Wrigley-Field, Elizabeth; Stokes, Andrew; Bor, Jacob. “American Millennials Are Dying at an Alarming Rate.” Slate (Aug 20, 2025).
