US Child Mortality Outpaces Other High-Income Nations, Study Shows

The United States has some catching up to do when it comes to the health and wellness of children. Despite being one of the wealthiest nations in the world, the gap in child mortality and health outcomes continues to widen between the US and other high-income countries.

A new study published in The Journal of the American Medical Association recently compared US child mortality and wellness with that of 18 other high-income nations, including Spain, Sweden, Canada, New Zealand, Germany and the UK.

The findings were stark. Despite a global decline in infant mortality over the past decade, deaths among babies under 1 remain disproportionately higher in the US. American babies are 2.2 times more likely to die from preterm birth and 2.4 times more likely to die from sudden unexpected infant deaths (SUIDs) compared with babies in other wealthy nations.

Among children ages 1 to 19, the disparity was even greater. From 2020 to 2022, youth in the US were more than twice as likely to die as their peers abroad. Firearm deaths, now the leading cause of death among US youth, were more than 15 times higher than in other high-income countries. Car crashes, the second leading cause of death, occurred at 2.5 times the rate of those in peer nations.

Christopher B. Forrest, MD, PhD, lead author of the study and a professor of pediatrics at Children’s Hospital of Philadelphia, found the growing mortality gap between the US and other countries particularly “disturbing.” Rates were relatively equivalent in 1960, he told JAMA Medical News, but then they opened up in the 1970s and 1980s and have only grown further apart since.

Mortality isn’t the only concern on the rise. Nearly 31% of American youth now report chronic conditions such as sleep apnea and obesity, up from 26% in 2010. Mental health diagnoses have also surged, with cases of anxiety, major depression, and eating disorders nearly tripling among children ages 3 to 17 over the past decade.

“The tragedy is that many of the deaths from these three causes—SUID, prematurity and firearms—are preventable,” researchers wrote in an accompanying editorial. The study identified five broad domains that contribute to the US health disadvantage: health care, behaviors, socioeconomic conditions, the environment and public policies, with various elements from each of these domains intersecting to create the perfect storm.

For instance, rising SUID mortality may be tied to factors such as COVID-19 and other respiratory viruses, maternal opioid use and unsafe sleep practices. Greater access to firearms has likely fueled the sharp rise in gun deaths. And increased use of smartphones and social media may be driving sleep disruption, loneliness and depression. These conditions are often interconnected, as when activity limitations contribute to depression and obesity, which in turn can lead to poor sleep.

The researchers acknowledge the findings may feel discouraging, but stress that change is possible. “Policymakers who are invested in enhancing children’s health must intervene. They could increase social media protections, invest in antipoverty measures such as child tax credits and income transfers, broaden health insurance coverage, invest in primary care and pass firearm safety laws,” researchers said. “Without decisive action to change the trajectory, the US health disadvantage is likely to worsen.”