Monday, July 17, 2023

The missing Americans: Unprecedented US mortality far exceeds other wealthy nations

A new study found that more than one million US deaths per year—including many young and working-age adults—could be avoided if the US had mortality rates similar to its peer nations.

Peer-Reviewed Publication

BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH

A new study found that more than one million US deaths a year—including many young and working-age adults—could be avoided if the US had mortality rates similar to its peer nations.

In 2021, 1.1 million deaths would have been averted in the United States if the US had mortality rates similar to other wealthy nations, according to a new study led by a Boston University School of Public Health (BUSPH) researcher.

Published in the journal PNAS Nexus, the study refers to these excess deaths as "Missing Americans," because these deaths reflect people who would still be alive if the US mortality rates were equal to its peer countries.

Comparing age-specific death rates in the U.S. and 21 other wealthy nations from 1933 through 2021, the authors find that current death rates in the US are much higher than other wealthy nations, and the number of excess U.S. deaths has never been larger.

“The number of Missing Americans in recent years is unprecedented in modern times,” says study lead and corresponding author Dr. Jacob Bor, associate professor of global health and epidemiology at BUSPH.

Nearly 50 percent of all Missing Americans died before age 65 in 2020 and 2021. According to Dr. Bor, the level of excess mortality among working age adults is particularly stark. “Think of people you know who have passed away before reaching age 65. Statistically, half of them would still be alive if the US had the mortality rates of our peers. The US is experiencing a crisis of early death that is unique among wealthy nations.”

The COVID-19 pandemic contributed to a sharp spike in mortality in the US—more so than in other countries—but the new findings show that the number of excess US deaths has been accelerating over the last four decades. Dr. Bor and colleagues analyzed trends in US deaths from 1933 to 2021, including the impact of COVID-19, and then compared these trends with age-specific mortality rates in Canada, Japan, Australia, and 18 European nations.

The US had lower mortality rates than peer countries during World War II and its aftermath. During the 1960’s and 1970’s, the US had mortality rates similar to other wealthy nations, but the number of Missing Americans began to increase year by year starting in the 1980’s, reaching 622,534 annual excess US deaths by 2019. Deaths then spiked to 1,009,467 in 2020 and 1,090,103 in 2021 during the pandemic. From 1980 to 2021, there were a total of 13.1 million Missing Americans.

The researchers emphasize that this mortality crisis is a multiracial phenomenon and is not specific to minoritized groups. Black and Native Americans are overrepresented in these measures, with mortality rates in early adulthood (ages 15-44) that were five and eight times higher than the average of other wealthy nations. The team also says that the history of structural racism in the US, including policies such as slavery and redlining, has contributed to racial and ethnic disparities in wealth and in access to education, housing, and healthcare that drive leading causes of worse mortality rates, particularly at young ages.

Still, two-thirds of the Missing Americans are White, a result of the larger population of White Americans, their older age distribution, and death rates that are significantly higher than other wealthy nations.

“Living in the US is a risk factor for early death that is common across many US racial and ethnic groups. Whereas most health disparities studies assess differences between US racial/ethnic groups, such an approach renders the poor health of Whites invisible and grossly underestimates the health shortfall of minoritized groups,” Dr. Bor says. “By using an international benchmark, we show that Americans of all races and ethnicities are adversely affected by the US policy environment, which places a low priority on public health and social protections, particularly for low-income people.”

Accounting for future years of life lost due when a person dies prematurely, the team estimates that in 2021, excess U.S. mortality translated to 26.4 million years of life lost relative to the mortality rates of peer nations. They connect the large excess mortality burden to the failure of US policy to adequately address major public health issues, including the opioid epidemic, gun violence, environmental pollution, economic inequality, food insecurity, and workplace safety. The COVID-19 pandemic exacerbated many of these issues, particularly among lower-income and minority groups, and now that most of the safety-net policies created during COVID-19 have expired, vulnerable groups have lost vital support.

“We waste hundreds of billions each year on health insurers’ profits and paperwork, while tens of millions can’t afford medical care, healthy food, or a decent place to live,” says study senior author Dr. Steffie Woolhandler, Distinguished Professor at the School of Urban Public Health at Hunter College, City University of New York. “Americans die younger than their counterparts elsewhere because when corporate profits conflict with health, our politicians side with the corporations.”

In comparison to the US, other countries also had higher vaccination uptake and mask policies during the Omicron wave, and this layered mitigation was associated with fewer COVID-19 cases.

The findings raise a number of urgent questions that will be critical to address in future research, says study coauthor Dr. Andrew Stokes, assistant professor of global health at BUSPH. For example, he says, "Which geographic areas are disproportionately responsible for the Missing Americans, and what were their causes of death? Answers to these questions may help to clarify policy solutions.”

At the moment, Dr. Bor says he is not optimistic that mortality rates will reverse in the near future, even as COVID-related deaths continue to wane from their 2021 peak.

“The US was already experiencing more than 600,000 Missing Americans annually before the pandemic began, and that number was increasing each year. There have been no significant policy changes since then to change this trajectory,” he says.

“While COVID-19 brought new attention to public health, the backlash unleashed during the pandemic has undermined trust in government and support for expansive policies to improve population health,” said Dr. Bor. “This could be the most harmful long-term impact of the pandemic, because expansion of public policy to support health is exactly how our peer countries have attained higher life expectancy and better health outcomes.”

About Boston University School of Public Health

Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.

JOURNAL

PNAS Nexus

DOI

10.1093/pnasnexus/pgad173

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Missing Americans: Early death in the United States—1933–2021

THE SHOW ME STATE

University of Missouri researchers driving innovative solutions to advance use of ‘plastic’ roads

Members of the Mizzou Asphalt Pavement and Innovation Lab are on the leading-edge of developing sustainable plastic waste road pavement mixtures

Business Announcement

UNIVERSITY OF MISSOURI-COLUMBIA

Driving innovative solutions for advancing use of ‘plastic’ roads — VIDEO: UNIVERSITY OF MISSOURI RESEARCHERS ARE ON THE LEADING-EDGE OF DEVELOPING SUSTAINABLE PLASTIC WASTE ROAD PAVEMENT MIXTURES. view more
CREDIT: UNIVERSITY OF MISSOURI

Millions of roads across the United States are constructed with asphalt pavement that’s deteriorating over time. Now, researchers at the University of Missouri are using recyclables, including plastic waste, as a sustainable solution to fix America's fracturing road system.

In partnership with the Missouri Department of Transportation (MoDOT), researchers from the Mizzou Asphalt Pavement and Innovation Lab (MAPIL) recently created a real-world test road using recycled materials like scrap tires and plastic waste along a portion of Interstate 155 in the Missouri Bootheel. By increasing the sustainability of asphalt mixes, this innovative method can help reduce the number of items going into landfills or leaking into the environment, said Bill Buttlar, director of MAPIL.

“Missouri is the Show-Me State, so we take a very pragmatic view,” Buttlar said. “The science can be thorny and difficult, but we are up to the task. We’re excited that while our approach is complicated in the lab, its simple to execute in the field, so it makes it easily adaptable, scalable and cost-effective to incorporate into many types of road environments.”

The I-155 project takes the group’s previous test road, installed along a stretch of Stadium Boulevard in Columbia, Missouri, one step further. Instead of just testing four different types of recycled materials, the I-155 project will evaluate the real-world effectiveness of nine different types of recycled materials in the creation of asphalt pavement. This includes three different types of polyethylene (PE) — a material commonly found in plastic grocery bags — and ground tire rubber, which is a newer way of disposing scrap tires.

“These projects afford us an opportunity to intentionally build the next generation of roads with these materials not as a type of linear landfill, but to also help the environment while making the value of dollars spent on transportation infrastructure like this stretch farther into the future,” said Buttlar, who is also the Glen Barton Chair in Flexible Pavements.

MU is on the leading-edge of this type of work in the U.S. because its team has addressed most of the translational research questions like durability and safety that could prevent a general contractor or department of transportation from adopting this ground-breaking strategy.

“We don’t just live in the laboratory,” Buttlar said. “In the field of transportation material research, we need to see how all the various materials used to construct a road — the rock, the asphalt and the recycled materials — behave in the real world and gel together to build a road. Asphalt is liquified with heat, and when you put an additive in like a plastic or rubber material, you must get everything to bond together with good adhesion. But we’re only going to know if that happens successfully when we produce it on a full-scale level and then expose it to elements, such as different weather conditions and heavy traffic.”

MAPIL specializes in a dry process, which allows the researchers to easily add the recyclables directly into the mixture before it’s applied to a road surface.

“The form, shape and size of the plastics bring different challenges in how the material flows, how it behaves and how it mixes,” said Punya Rath, an assistant research professor in the Department of Civil and Environmental Engineering who works at MAPIL. “So, we did extensive small-scale testing for almost an entire year before we moved to a larger scale out in the field with contractors.”

One advantage of this process is that the researchers can test the mixtures in the field using a mobile research lab, which they developed and used for both the Stadium Boulevard and I-155 projects.

“It helps the Missouri Department of Transportation (MoDOT) immensely to have a mobile research lab on-site in the field that has the ability to rapidly test samples and provide results within 24-48 hours to better inform the process,” Rath said.

Citing environmental concerns, Buttlar said the team makes sure everything they do is within the current limits as established by the Environmental Protection Agency (EPA).

“We are designing the material to be able to hold or capture the environmental by-products at the highest percentage for the longest amount of time. It’s not going to be a 100% containment,” Buttlar said. “Everything built in a natural environment will degrade over time, so that’s why EPA has standards for everything, and we make sure we are safely within those standards.”

In partnership with MoDOT, University of Missouri researchers recently created a real-world test road using recycled materials along a portion of Interstate 155 in the Missouri Bootheel.

CREDIT

Graphic by Samantha Novak/University of Missouri

An asphalt pavement test mixture sample designed by the Mizzou Asphalt Pavement and Innovation Lab is ready for further lab testing to determine its strength and durability.

Lab staff in the Mizzou Asphalt Pavement and Innovation Lab show the plastic waste particles that are being added to the pavement mixture. The lab is located inside the University of Missouri College of Engineering.

A pavement mixture using recycled plastic is applied to a section of Stadium Boulevard in Columbia near U.S. Highway 63 in 2021.

Steam rises from the newly poured plastic waste pavement mixture as an asphalt roller compacts the mixture into a smooth driving surface along Stadium Boulevard in Columbia in 2021.

CREDIT

University of Missouri

Editor’s Note:

Both the Stadium Boulevard and I-155 projects were developed in collaboration with the Missouri Department of Transportation (MoDOT) as part of their ongoing partnership with the University of Missouri System’s Missouri Center for Transportation Innovation (MCTI). While both projects only involved repairing an existing road surface, Buttlar said there have been some preliminary talks between his team and MoDOT on how to incorporate more sustainable asphalt pavement mixtures into the building of a third lane on Interstate 70 across Missouri.

For more on the story, please see:

METHOD OF RESEARCH

Observational study

What causes mudslides and floods after wildfires? Hint: It’s not what scientists thought

Peer-Reviewed Publication

UNIVERSITY OF SOUTHERN CALIFORNIA

In 2020, one of the largest wildfires in Los Angeles County raged across the San Gabriel Mountains, scorching more than 115,000 acres, damaging or destroying over 150 structures and raining ash and smoke down on pandemic-weary Angelenos.

But even after exhausted firefighters had finally snuffed out the flames, the Bobcat Fire — like other so-called “mega-fires” that have become more common due to climate change — carried the potential to wreak more havoc in its wake. As rainstorms deluge burnt areas, flooding, mudslides and debris flow can compound the fire’s damage.

Understanding how water accumulates and monitoring the movement of runoff and streamflow in burn areas helps authorities predict when and where these post-wildfire events might occur so they can provide affected residents with early warning of flash flooding and debris movement.

A slippery slope

Common knowledge has long held that loss of vegetation during a fire leaves soil vulnerable to erosion because the plant roots that hold the soil in place wither and die. Scientists, however, have long held a different view, that as leaves burn, their waxy coating forms an organic, oily substance on the soil’s surface. This waxy coating creates a water-repellant layer at or near the surface. Scientists believed this layer prevented the ground from absorbing water, resulting in rapid water runoff akin to a Slip ‘N Slide that carries mud and debris.

New research published in Nature Communications has called that scientific theory into question.

A watershed finding

Images of the 2020 Bobcat Fire area indicate soil burn severity and the locations the researchers studied. (Image Source: a- USDA Forest Service; b- A.J. West; d- Pléiades ©CNES, Distribution AIRBUSDS, sourced via SkyWatch Space Applications Inc., and USGS 3D Elevation Program.)

Scientists at the USC Dornsife College of Letters, Arts and Science, in collaboration with researchers from the University of Michigan, the U.S. Geological Survey and Rutgers University, monitored two wet seasons following the Bobcat Fire, from December 2020 to March 2022. The team concluded that water was, in fact, being absorbed by the burnt ground that contained this waxy coating.

Specifically, the team studied three watersheds — areas of land that drain rainfall and snowmelt into streams and rivers — in Southern California’s San Gabriel Mountains. Two of the watersheds burned during the 2020 Bobcat Fire and the other was mainly untouched.

The researchers found that post-wildfire, a significant portion of the water flow in all three watersheds came from water that had been absorbed in the ground.

Joshua West, professor of Earth sciences who led the study at USC Dornsife, said it was no surprise that the flow of water and debris in the burned area’s stream was four to 10 times greater than the flow in the unburnt area’s stream. What he didn’t expect was that stormwater had permeated the ground in both of the burnt watersheds.

This finding contradicted scientists’ previous beliefs that little water would be absorbed in the burnt watershed due to the presence of waxy soils.

In the unburnt watershed, however, the researchers found that trees absorbed the water as anticipated, preventing it from reaching streams.

West and PhD candidate Abra Atwood surmised that, in keeping with the popular notion, increased water in rivers originated from the burnt areas because burned trees and vegetation could not retain water in their roots as they normally would, but not from the inability of the soil to absorb water.

The research team’s finding that the water-repellant layer does not prevent water from being absorbed into the soil strengthened their hypothesis that the water in streams comes from both rainfall and groundwater, leading to increased flooding in burnt areas versus unburnt.

Water build-up poses enduring threat

Identifying areas that are at high-risk for debris flow and mudslides and accurately predicting the amount of debris flow following rainfall in burn areas depends on understanding how water infiltrates the soil in different areas and how it contributes to the flow of streams.

Also, the dynamics of water flow and how water accumulates below the surface can significantly impact how quickly landscapes recover after a wildfire. This recovery affects the stability of hill slopes and helps buffer forests against severe drought.

On the flip side, water accumulation can contribute to landslides for up to four years after a fire as pressure builds up in the soil.

“The underground water accumulation suggests that the potential for landslides extends far beyond the two years following the fire, posing an enduring problem,” West said. “The abundance of water stored in areas affected by the Bobcat Fire, for example, could serve as a harbinger of future flooding concerns in the years to come.”

West is confident that the study’s findings hold important information that can be used by the USGS to improve burn area monitoring and predict flooding and mudslides after a wildfire.