Some stunning numbers

Results We analyzed 3 392 364 deaths among the full US population aged 25-44 years from 1999 to 2023. Mortality increases across most causes of death produced substantial excess deaths compared with extrapolations of pre-2011 trends (Figure). Early adult excess mortality was 34.6% higher than expected in 2019 and then further accelerated during the COVID-19 pandemic. In 2021, all-cause excess mortality was nearly 3 times what it had been in 2019 (116.2 vs 41.7 deaths per 100 000 population). In 2023, excess mortality decreased, but only to approximately midway between its 2019 and 2021 levels (79.1 deaths per 100 000 population). As a result, early adult mortality was 70.0% higher in 2023 than it would have been had pre-2011 trends continued, reflecting 71 124 excess deaths (Table).

The 5 causes of death that collectively accounted for almost three-quarters of the early adult excess mortality in 2023 were drug poisoning (31.8% of excess mortality), the residual natural-cause category (16.0%), transport-related deaths (14.1%), alcohol-related deaths (8.5%), and homicide (8.2%). Additionally, the combined contribution of cardiometabolic conditions, including circulatory and endocrine, metabolic, and nutritional, was substantial (9.2%).