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A rising share of Americans are dying before they can benefit from Medicare than in 2012 — including 38 percent more Black adults, according to a study published by researchers at Harvard and Brown University last week.
Between 2012 and 2022, there was a 27.2 percent increase in the rate of deaths among individuals aged 18 to 64, the study found, including a 27.7 percent rise in early deaths among white Americans. The rise in premature mortality means that many Americans are unable to access Medicare — designed as a universal health program for adults over 65 — even as they contribute to it through payroll taxes throughout their time in the workforce.
The study, published in JAMA Health Forum, builds on previous research published by three of its authors in March 2025 focused on avoidable deaths, or those that could have been prevented through timely, high-quality care. Both studies show that while other developed nations have reduced such deaths, the U.S. is moving in the opposite direction.
“Other countries are seeing improvements,” said Jose F. Figueroa, an associate professor at the Harvard School of Public Health who is one of the November study’s five authors. “Why is it that other countries are getting better, while in the U.S., a country that spends the most than any other country in the world, people are dying at much younger ages?”
The researchers — led by Irene N. Papanicolas, a professor at the Brown School of Public Health — looked at data gathered from Medicare enrollment and the Centers for Disease Control and Prevention to evaluate how many people die before qualifying for Medicare. They found that there were large disparities in mortality rates. In particular, a disproportionate share of Black Americans die before they reach 65, the age that Medicare benefits start.
The researchers also hoped to study death rates among Hispanic and Asian Americans, but data for those groups was harder to standardize, according to Figueroa.
Mortality rates have worsened in every state, a trend the researchers attribute to weaknesses in both health care access and health policy. West Virginia, New Mexico, and Mississippi had the highest premature death rates among adults, while Massachusetts and Utah had the lowest.
New Mexico, West Virginia, and Mississippi also saw the three greatest increases in rates of premature death between 2012 and 2022, according to the study. Only New Mexico, Utah, and Rhode Island did not see higher premature death rates among Black residents.
Papanicolas said it was shocking it was to see “how much worse things are getting in every state.” She added that the deteriorating outcomes point to a larger systemic issue that has persisted despite the U.S.’s astronomical health care spending.
Preventable issues, like drug overdoses, suicides, traffic accidents, and cardiovascular disease, were major causes of premature death in the U.S., Papanicolas said.
“We die more from gun deaths than any other country in the world, and we die more in car accidents than any other country in the world. These are all things you can prevent with a stronger public health system,” Figueroa said.
Both researchers said that policy changes designed to build stronger public health systems, as well as enforcing stricter regulations on firearms, ultra-processed food, alcohol, and opioids, could help address preventable deaths.
“This is not a simple solution. It’s not tweaking one program,” Figueroa said. “But there are things that we can do in more targeted ways for specific patient populations, specific groups, that slowly will get us there, if there’s a willingness to address the problem.”
“If you have a universal system, but that only kicks in after the people who need it most have died, then that's a failure of that universal system,” Papanicolas said.
