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September 23, 2026
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September 23, 2026—A new Milbank Quarterly study compares US life expectancy by state with that of other nations, finding that, in 2021, life expectancy in West Virginia and Mississippi resembled that of Bulgaria, Bangladesh, Azerbaijan, and Iraq. It also was lower than in very low-income countries such as North Korea and Syria.
In “US Life Expectancy and Increasing Mortality Rates: An Analysis of the Crisis,” by Steven H. Woolf, MD, MPH, of Virginia Commonwealth University, reports that US life expectancy in 2023 ranked 38th among countries with a population greater than 1 million. According to the article, US life expectancy rates began losing pace with other wealthy countries in the 1980s. A primary reason is rising mortality rates among American young adults and lower rates of survival to middle age. Woolf documents rising mortality rates from external causes—e.g., drug overdoses, alcohol-related disease, suicides, homicides—and from the early onset of hypertensive, liver, endocrine, and neurologic diseases, among others.
Data: United States Fertility and Mortality Database. Barbieri M, Winant C. U.S State Life Tables CSV + TXT 1941-2022. https://doi.org/10.7910/DVN/19WYUX. United Nations, Department of Economic and Social Affairs, Population Division (2024). World Population Prospects 2024, Online Edition. Standard projections for “most used” indicators downloaded November 18, 2025, at https://population.un.org/wpp/. See interactive map at milbank.org.
“Meaningful progress in addressing the US health disadvantage requires attention not only to root causes such as opioids, firearms, obesity, and mental health, but also to systemic factors that compromise the health of Americans, such as deficiencies in the health care system, socioeconomic precarity, and a lax regulatory environment,” Woolf said.
The analysis also points out that US life expectancy disparities by state have widened since the 1990s. This gap has grown while political polarization, including variation in social and economic policies affecting health, has widened across states, intensifying after 2010. States with Democratic governors achieved higher life expectancy, possibly due to more evidence-based health and social policies, but factors such as poverty, educational attainment, and higher rates of smoking and obesity may also be contributing.
“State policymakers should look at the leading causes of premature death in their states and consider adopting social and health policies that are known to improve population health,” said Debra Lubar, PhD, President of the Milbank Memorial Fund. “We should not accept high rates of premature death in any of our states.”
Sources of mortality data included the United Nations Department of Economic and Social Affairs, US Mortality Database, Centers for Disease Control and Prevention, and Organisation for Economic Cooperation and Development. The analysis examined life expectancy and age-specific mortality rates by country, cause-specific US mortality rates from 1999 through 2023, and cause-specific mortality rates in 16 high-income countries for comparison. A literature review examined potential explanations for the US health disadvantage, including the growing role of states and partisan polarization. This was supplemented by an analysis of state-level life expectancy and gubernatorial party affiliation for 1941–2022 and a comparison of state life expectancy in 2017–2021 with countries reporting similar life expectancy.