Global Disparities in Premature Mortality
(2025) In JAMA Health Forum 6(10).- Abstract
Importance: Persistent disparities in mortality across countries suggest uneven improvements in living standards and access to life-extending health technologies, as well as context-specific obstacles. Studies have analyzed cross-country inequality in mortality but have not widely contextualized those disparities in terms of developmental progress relative to a frontier representing a level of mortality achievable with broad access to the best health-enhancing technology and living standards available. Objective: To examine probability of premature death (PPD) - defined as probability of dying before 70 years of age - across countries and regions, benchmarking progress as years behind the lowest country-level PPD (the frontier). Design... (More)
Importance: Persistent disparities in mortality across countries suggest uneven improvements in living standards and access to life-extending health technologies, as well as context-specific obstacles. Studies have analyzed cross-country inequality in mortality but have not widely contextualized those disparities in terms of developmental progress relative to a frontier representing a level of mortality achievable with broad access to the best health-enhancing technology and living standards available. Objective: To examine probability of premature death (PPD) - defined as probability of dying before 70 years of age - across countries and regions, benchmarking progress as years behind the lowest country-level PPD (the frontier). Design and Setting: This cross-sectional study used aggregate-level data from the 2024 United Nations World Population Prospects and Human Mortality Database to calculate PPD across 7 global regions and the 30 most populous countries. Data were analyzed from May to September 2025. Main Outcome and Measures: The primary outcomes were PPD and the number of years behind the lowest country-level PPD. Results: The frontier PPD fell from 57% to 12% from 1900 to 2019. Sub-Saharan Africa's PPD in 2019 was 52%, corresponding to the 1916 frontier PPD. However, sub-Saharan Africa had converged toward the frontier by over 40 years since 2000, when it had a 65% PPD. China has been converging toward the frontier since 1970, having been 93 years behind the frontier PPD in 1970 (with a 60% PPD) and 35 years behind in 2019 (21% PPD). The US has diverged away from the frontier, having been 29 years behind in 1970 (38% PPD) and 38 years in 2019 (22% PPD). Of the regions included, the North Atlantic (Western Europe and Canada) was the closest to the frontier, being 13 years behind in 2019 (15% PPD). The US, Central and Eastern Europe, and sub-Saharan Africa were the furthest above the 2019 PPD Preston curve (ie, they had a greater PPD than predicted by their per capita gross domestic product). Conclusions and Relevance: In this cross-sectional study, disparities in PPD were likely to reflect major inequality in access to health-enhancing technologies and living standards, as well as context-specific obstacles. Technological and medical advancements leading to universal health benefits need to be rapidly and fairly disseminated.
(Less)
- author
- Karlsson, Omar LU ; Jamison, Dean T. ; Yamey, Gavin ; Bolongaita, Sarah ; Mao, Wenhui ; Chang, Angela Y. ; Norheim, Ole F. ; Ogbuoji, Osondu and Verguet, Stéphane
- organization
- publishing date
- 2025-10
- type
- Contribution to journal
- publication status
- published
- subject
- in
- JAMA Health Forum
- volume
- 6
- issue
- 10
- article number
- e253479
- publisher
- American Medical Association
- external identifiers
-
- pmid:41042526
- scopus:105017646719
- DOI
- 10.1001/jamahealthforum.2025.3479
- language
- English
- LU publication?
- yes
- id
- 90586499-b38a-4574-aba8-1ec776e6513f
- date added to LUP
- 2025-11-25 09:38:20
- date last changed
- 2025-12-09 10:58:53
@article{90586499-b38a-4574-aba8-1ec776e6513f,
abstract = {{<p>Importance: Persistent disparities in mortality across countries suggest uneven improvements in living standards and access to life-extending health technologies, as well as context-specific obstacles. Studies have analyzed cross-country inequality in mortality but have not widely contextualized those disparities in terms of developmental progress relative to a frontier representing a level of mortality achievable with broad access to the best health-enhancing technology and living standards available. Objective: To examine probability of premature death (PPD) - defined as probability of dying before 70 years of age - across countries and regions, benchmarking progress as years behind the lowest country-level PPD (the frontier). Design and Setting: This cross-sectional study used aggregate-level data from the 2024 United Nations World Population Prospects and Human Mortality Database to calculate PPD across 7 global regions and the 30 most populous countries. Data were analyzed from May to September 2025. Main Outcome and Measures: The primary outcomes were PPD and the number of years behind the lowest country-level PPD. Results: The frontier PPD fell from 57% to 12% from 1900 to 2019. Sub-Saharan Africa's PPD in 2019 was 52%, corresponding to the 1916 frontier PPD. However, sub-Saharan Africa had converged toward the frontier by over 40 years since 2000, when it had a 65% PPD. China has been converging toward the frontier since 1970, having been 93 years behind the frontier PPD in 1970 (with a 60% PPD) and 35 years behind in 2019 (21% PPD). The US has diverged away from the frontier, having been 29 years behind in 1970 (38% PPD) and 38 years in 2019 (22% PPD). Of the regions included, the North Atlantic (Western Europe and Canada) was the closest to the frontier, being 13 years behind in 2019 (15% PPD). The US, Central and Eastern Europe, and sub-Saharan Africa were the furthest above the 2019 PPD Preston curve (ie, they had a greater PPD than predicted by their per capita gross domestic product). Conclusions and Relevance: In this cross-sectional study, disparities in PPD were likely to reflect major inequality in access to health-enhancing technologies and living standards, as well as context-specific obstacles. Technological and medical advancements leading to universal health benefits need to be rapidly and fairly disseminated.</p>}},
author = {{Karlsson, Omar and Jamison, Dean T. and Yamey, Gavin and Bolongaita, Sarah and Mao, Wenhui and Chang, Angela Y. and Norheim, Ole F. and Ogbuoji, Osondu and Verguet, Stéphane}},
language = {{eng}},
number = {{10}},
publisher = {{American Medical Association}},
series = {{JAMA Health Forum}},
title = {{Global Disparities in Premature Mortality}},
url = {{http://dx.doi.org/10.1001/jamahealthforum.2025.3479}},
doi = {{10.1001/jamahealthforum.2025.3479}},
volume = {{6}},
year = {{2025}},
}