Data on premature deaths—a measure quantifying mortality that occurs prior to average life expectancy—is an important public health measure. As we described in a prior blog, this measure can be used to understand issues such as the societal toll of preventable deaths, since so many deaths that occur among young people stem from avoidable causes, such as traffic collisions, drug overdoses, and suicide.
In this blog, we continue in our discussion of premature deaths, describing examples of what preventable deaths data can tell us about public health trends and variation in premature deaths across demographic subgroups.
Premature Death Across America
Premature death varies greatly across the states. For instance, the estimate of age-adjusted years of potential life lost (YPLL) in 2023 for Mississippi, at 11,215 YPLL, was the highest among the states—more than double the estimate for Massachusetts, at 5,230 YPLL, which was the lowest among the states. This divide suggests meaningful differences in how Americans experience health and safety depending on the state they live in.
Table 1. Top 5 States: Lowest Premature Deaths, 2023
State | Age-Adjusted Years of Potential Life Lost (AA YPLL) |
|---|---|
Massachusetts | 5,230 |
New Jersey | 5,347 |
Connecticut | 5,647 |
New York | 5,654 |
Minnesota | 5,780 |
Table 2. Bottom 5 States: Highest Premature Deaths, 2023
State | Age-Adjusted Years of Potential Life Lost (AA YPLL) |
|---|---|
Mississippi | 11,215 |
West Virginia | 11,105 |
New Mexico | 10,799 |
Louisiana | 10,551 |
Alabama | 10,442 |
Regional Disparities in Premature Death
Let’s go beyond the top and bottom five, looking at age-adjusted years of potential life lost by state (Figure 1 below).
Figure 1. Map of Age-Adjusted Years of Potential Life Lost (YPLL) by State
Seeing the country’s AA YPLLs visually highlights just how much these values vary regionally, with higher estimates of premature death in the Southeast and lower estimates in the upper Midwest and Northeast.
The South’s generally higher rates of premature death may be due to factors such as:
- lower median incomes,
- reduced access to health care, and
- higher rates of chronic disease.1
Northeastern states, on the other hand, have a reputation for more robust health care systems, greater investment in public health interventions, and stronger social safety nets, which may contribute to their relatively lower estimates of premature death.2
Causes of Premature Death: Two Decades of Shifting Trends
While premature death rates have remained relatively stable since 2001, the underlying story and causes behind these deaths have shifted over time.
Causes of premature death are divided into general categories. Some of these categories include:
- Malignant neoplasms (cancer)
- Heart disease
- Unintended injury
- Suicide death
- Homicide
Commonly among the top causes of premature death are malignant neoplasms (i.e., cancer) and unintentional injury.
Unintentional injury “refers to fatal and nonfatal injuries not deliberately inflicted, including any such injury described as an ‘accident’, regardless of whether inflicted by oneself or by another person.”3
This broad category encompasses deaths from unintentional poisonings (as caused by the opioid epidemic, for example), unintentional traffic fatalities, unintentional falls (workplace accidents, for example), and unintentional drownings, among others.4
As shown in Figure 2, the leading cause of premature death for the U.S. has undergone a transformation, with premature deaths from cancer consistently decreasing while premature deaths from unintentional injury have nearly doubled over the past two decades.
Figure 2. Age-Adjusted Years of Potential Life Lost (YPLL) for Unintentional Injury and Cancer, 2001–2023
Various medical advancements have contributed to reductions in premature deaths due to cancer. Improved screenings allow cancers to be caught earlier, at which point they’re easier to treat.5 Revolutionary treatments, including targeted therapies and immunotherapy, have been added to improvements in traditional cancer treatments. Together, these have transformed many cancers from a short-term death sentence into chronic conditions that people can live with for years.6
Also contributing to reductions in premature deaths due to cancer are efforts to decrease or prevent causes of cancer, such as decreasing smoking rates.7
Conversely, the dramatic increase of premature deaths from unintentional injury tells a different story. There are multiple causes contributing to the increase in deaths from unintentional injury. For example, the opioid epidemic alone has claimed over 645,000 American lives, predominantly young and middle-aged adults.8,9
This distinction between cancer and unintentional injury as leading causes of premature death taking different trajectories illustrates the potential for new public health insights. Further research into this topic could reveal potential factors that might have influenced this change, such as differences in health care access and utilization.
While the number of premature deaths varies dramatically across the country, as we saw in Figure 1, the leading cause of premature death in 2023 is remarkably consistent across the states. In every state except for Nebraska, the leading cause of premature death is unintentional injury.
If we look beyond unintentional injury, a more complex picture emerges: The second leading cause of premature death varies across states, revealing distinct regional health profiles and risk factors. In the majority of states (41), cancer emerges as the second leading cause of premature death, while others (9) see heart disease as their second leading killer.
In Washington D.C., on the other hand, homicide emerged as the number two killer after unintentional injury, which could point to impacts of social and economic factors, like poverty and income inequality, which have been linked to increased homicide rates.10
Premature Death by Race/Ethnicity
Both the predominant causes of premature death and the overall burden of premature death vary greatly by race/ethnicity.
The Scale of Racial Disparities
Nationally, premature death is the highest in Non-Hispanic (NH) American Indian and Alaska Native (AIAN) populations, and the gap in premature death between NH AIAN populations and other races/ethnicities has increased since 2009 (Figure 3). These trends vary state to state, but, generally, NH Black or NH AIAN typically experience the most premature death.
Figure 3. Age-Adjusted Years of Potential Life Lost (YPLL) by Race/Ethnicity, 2009–2023
Hispanic populations experience a lower rate of premature death than White populations, even though they are a community of color that has a higher risk profile due to economic disadvantages (i.e., lower household income, education, and health insurance coverage) and higher rates of certain chronic illnesses (i.e., diabetes, kidney failure, and chronic liver disease).11 This paradox is known as the Hispanic Health Paradox, a phenomenon with explanations that remain debated.
Leading Causes of Premature Death by Race/Ethnicity
At the national level, NH AIAN, NH Black, NH White, and Hispanic populations see the highest premature death from unintentional injury.
For Hispanic populations, the leading cause of premature was unintentional injury in every state, while other measured groups had some level of variation on leading cause from state to state. NH Asian American/Pacific Islander/Native Hawaiian (AAPINH), see the most premature death from cancer in almost every state (44).
Looking beyond unintentional injuries to the second leading cause of premature death by race/ethnicity reveals differences and disparities. For example:
- NH AAPI, NH White, and Hispanic populations attribute the second highest premature death to cancer
- NH AIAN populations experience a high amount of premature death from heart disease and liver disease
- NH Black populations have heart disease as their second highest cause of premature death
Understanding the Causes
As we have seen throughout this analysis, there is state- and subpopulation-level variation in the estimates of premature death and the most common causes. Below, we look to understand how different leading causes of premature death could be influenced by these and other factors:
- Cancer as the leading cause of premature death for NH AAPINH populations may be influenced by a higher rate of infectious diseases that cause cancer, exposure to carcinogens, or a lesser likelihood of being screened for cancer.12
- NH Black populations have a higher rate of risk factors for heart disease, such as hypertension, diabetes, smoking, obesity, and physical activity.13 However, it is essential to note that Black populations also experience structural and social inequities that lead to mistrust in the medical system and other institutions, a higher rate of food insecurity and lower access to nutritious foods, and worse access to care.14,15 All of these factors contribute to the increased rate of risk factors for heart disease.14
- The higher rate of mortality and premature death among NH AIAN populations could be the result of their receiving poorer care and having a higher degree of vulnerability due to historical conditions.16
Gender Differences in Premature Death
The gender gap in premature death is one of the most consistent patterns across all states and demographic groups. Figure 4 shows the age-adjusted YPLL rates by sex and the disparities that exist between males and females: In every state (except South Dakota) the AA YPLL for males is twice as high for females, representing thousands of years of life lost disproportionately among men. The top cause of premature death among males is unintentional injury in every state except Washington D.C., where homicide is the top cause.
Figure 4. Age-Adjusted Years of Potential Life Lost (YPLL) for Males and Females by State
Note: The percentage shown for each state in Figure 4 represents the percent increase for males compared to females.
Conclusion
The story of premature death in America is ultimately a story about geographic, racial, and gender disparities that cost our nation millions of years of life annually. While medical advances have dramatically reduced premature deaths from cancer, the rise of unintentional injuries, particularly from the opioid crisis, has created new patterns of loss that disproportionately impact young and middle-aged Americans.17
The data show that men lose twice as many years of life as women, and that Southern states rank among the highest in premature mortality. Understanding these patterns through the lens of years of potential life lost helps us see where public health interventions could have the greatest impact—not only saving lives, but also preserving the decades of contribution, productivity, and relationships that make communities thrive.
The challenge now is translating these insights into policies and programs that can begin to close the gaps that separate the healthiest Americans from those dying decades too soon.
Want to explore more on premature death? Analyze the data, make data visualizations, and do your own testing on State Health Compare, our free data tool. You can also check out many other data and measures related to premature death, like our Drug Poisoning Deaths measure or Income Inequality (Gini Coefficient).
Works Cited
[1] Cafer, A., Rosenthal, M., Laurent, B., Conner, J., & Anderson, R. (2020). Health Landscapes in the South: Rurality, Racism, and a Path Forward. Study the South. https://egrove.olemiss.edu/cgi/viewcontent.cgi?article=1004&context=studythesouth
[2] Studio/B. (n.d.). What New England Gets Right About Health - And What Other States Can Learn. Boston Globe. Retrieved from https://sponsored.bostonglobe.com/point32health/healthiest-states/
[3] Centers for Disease Control and Prevention. (n.d.-b). WISQARS Glossary. Centers for Disease Control and Prevention. https://wisqars.cdc.gov/glossary/
[4] Centers for Disease Control and Prevention. (n.d.-b). Injuries and Violence Are Leading Causes of Death. Centers for Disease Control and Prevention. https://wisqars.cdc.gov/animated-leading-causes/
[5] U.S. Department of Health and Human Services. (2025, January 14). Prevention and screening drive drop in cancer deaths. National Institutes of Health. https://www.nih.gov/news-events/nih-research-matters/prevention-screening-drive-drop-cancer-deaths
[6] McDowell, S., Ludwig Rausch, S., & Simmons, K. (2019, December 30). Cancer research insights from the latest decade, 2010 to 2020. American Cancer Society. https://www.cancer.org/research/acs-research-news/cancer-research-insights-from-the-latest-decade-2010-to-2020.html
[7] SHADAC analysis of CDC WISQARS, State Health Compare, SHADAC, University of Minnesota, https://statehealthcompare.shadac.org/.
[8] Federal Communications Commission. (n.d.). Focus on Broadband and Opioids. https://www.fcc.gov/reports-research/maps/connect2health/focus-on-opioids.html
[9] Spencer, M. R., Grant, M. F., & Miniño, A. M. (2024, March). Drug Overdose Deaths in the United States, 2002–2022. National Center for Health Statistics. https://www.cdc.gov/nchs/data/databriefs/db491.pdf
[10] McCool, W. C., & Codding, B. F. (2023). US homicide rates increase when resources are scarce and unequally distributed. Evolutionary Human Sciences, 6. https://doi.org/10.1017/ehs.2023.31
[11] Fernandez, J., García-Pérez, M., & Orozco-Aleman, S. (2023). Unraveling the Hispanic Health Paradox. Journal of Economic Perspectives, 37(1), 145–168. https://doi.org/10.1257/jep.37.1.145
[12] Lee, R. J., Madan, R. A., Kim, J., Posadas, E. M., and Yu, E. Y. (2021). Disparities in Cancer Care and the Asian American Population. The Oncologist, 26(6), 453–460. https://doi.org/10.1002/onco.13748
[13] UChicago Medicine. (2021, February 26). Heart disease and racial disparities: Why heart disease is more common in Black patients and how to prevent it. https://www.uchicagomedicine.org/forefront/heart-and-vascular-articles/heart-disease-and-racial-disparities
[14] Artiga, S., Hill, L., and Presiado, M.. (2024, February 22). How Present-Day Health Disparities for Black People Are Linked to Past Policies and Events. KFF. https://www.kff.org/racial-equity-and-health-policy/how-present-day-health-disparities-for-black-people-are-linked-to-past-policies-and-events/
[15] Hostetter, M., Klein, S. (2021, January 14). Understanding and Ameliorating Medical Mistrust Among Black Americans. The Commonwealth Fund. https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans
[16] Mileo Gorzig, M., Feir, D. L., Akee, R., Myers, S., Navid, M., Tiede, K., & Matzke, O. (2022). Native American Age at Death in the USA. Journal of Economics, Race, and Policy, 5(3), 194–209. https://doi.org/10.1007/s41996-021-00095-0
[17] Planalp, C., Stewart, A. (2024, October). Changing Dynamics in the Opioid Crisis Since the COVID-19 Pandemic. SHADAC. https://shadac-pdf-files.s3.us-east-2.amazonaws.com/s3fs-public/2025-01/2024%20Opioid%20Brief_FINAL_0.pdf