Risk of dying from chronic disease in the U.S. declined, but there are caveats, study says

STAT News – Wednesday, September 10, 2025
By Isabella Cueto

The popular sentiment that Americans’ health is on a hellish downward spiral may not be true — or at least not entirely — according to a new study of global death data. From 2010 to 2019, the risk of dying from a chronic disease between birth and age 80 declined in most countries, including the U.S.

The catch? Those improvements got smaller over time. In the U.S., that downward trend slowed down from 2010 to 2019 as compared to the previous decade, according to a consortium of researchers who published their findings in The Lancet on Wednesday. Many other nations had similar slowdowns in progress, but the U.S. was one of the worst among its peers.

The U.S. also saw a “rare phenomenon” among peer nations: A rise in chronic disease mortality among 20-to-45-year-olds, the authors found. The study feeds into a swelling sense of crisis in the U.S., fed by the federal government, over multiplying health problems, more illness in childhood, and a sense that little so far has changed the nation’s trajectory.

“I could say this is good news, bad news, but maybe … it’s complex news,” Majid Ezzati, a professor at the Imperial College of London’s School of Public Health, told STAT.

Ezzati is one of the authors of the study, known informally as NCD Countdown 2030. (NCD stands for noncommunicable diseases.) The work was partly funded by the nongovernmental advocacy organization NCD Alliance, which focuses on noncommunicable diseases, and accepts funding from disease advocacy organizations and pharmaceutical companies that sell chronic disease treatments.

While other studies have summarized the state of disease and death in different parts of the world, The Lancet paper uses World Health Organization death data to compare nations against themselves. It also offers certain countries as standard-bearers in their respective regions. “They don’t have to do well in every disease, but they have to do well in many diseases,” Ezzati said.

Denmark was a leader among high-income western countries because it saw the biggest decline in chronic disease deaths from 2010 to 2019, even if it struggled in certain categories. South Korea was a standout among high-income, highly developed nations for pushing its already-low mortality rates even lower in the time period researchers analyzed.

The authors acknowledge that the quality or availability of mortality data can vary greatly by country. Their analysis is a high-level view of chronic disease across the world, but it does not offer detailed information on what is driving disparities within or between nations.

Death data can also be flawed, only capturing recent illness and not long-term factors, said Xiaomei Ma, a professor of epidemiology at the Yale School of Public Health. She was not involved with the study.

While the U.S. still saw a decline in the risk of dying from a chronic disease, it had the smallest declines of its peers, and slowed down “a fair amount” between 2000 and 2019, said Ezzati. For an American woman between the ages of 30 and 70, the probability of dying from cancer, heart disease, chronic obstructive pulmonary disease or diabetes went from 13% in 2001 to 10% in 2010 — a 3 percentage-point change. That dropped to a single percentage-point change between 2010 and 2019. The slowdown was the same for American men, though they had an overall higher risk of dying from chronic disease throughout the study years.

Back when he worked at Harvard University, Ezzati conducted a government-funded study that made the disturbing finding that chronic disease was driving down life expectancy in some parts of the country, such as Appalachia and the Deep South. Women were especially hard-hit. It was big news at the time, in 2008.

Ever since, the problem has “gone on and gone on, and has spread in the U.S., to the point that it has slowed down the national performance,” he told STAT.

The paper serves as a warning, said Ma. As Health and Human Services Secretary Robert F. Kennedy Jr. often mentions, the U.S. spends the most per capita on healthcare among developed nations, and has one of the worst life expectancies.

“We really need to act soon, because it’s already a lagged phenomenon,” Ma said. Chronic disease-related deaths often happen years or decades after a person first becomes ill. If deaths were already speeding up in 2019, that’s worrisome, Ma said.

Some of the issues in the U.S. are different now than they were a few decades ago — less HIV/AIDS and more Alzheimer’s disease — but other conditions, such as heart disease, stroke and chronic obstructive pulmonary disease, have been stubborn killers for decades. Reductions in those illnesses have been hard-earned, though they have occurred in part because of better treatments and prevention efforts.

In a few areas, like lung cancer and kidney diseases, the U.S. did better in the 2010s than in the decade before. Reductions in lung cancer deaths in men, specifically, were a key success for the U.S. Improved screening and aggressive tobacco control campaigns played a part in that, experts say.

Yet the risk of dying from other illnesses increased over time. The U.S., like all of its high-income, Western peers, did worse on ischemic heart disease and strokes from 2010 to 2019 than in the decade prior. (New data from the CDC showed deaths from heart disease rose in 2024 from the previous year, suggesting a continuation of the problem.) The risk of death from Alzheimer’s disease, substance use disorder, diabetes, liver cirrhosis, liver cancer, and pancreatic cancer also increased, as it did in many countries.

Alcohol use disorders, diabetes and diabetes-related kidney disease remain key threats in many parts of the world. To Ezzati, one takeaway is this: Addressing several prominent illnesses will prevent more deaths than focusing too narrowly on certain diseases. Ma’s research has shown her it’s more about how the healthcare system uses its resources. Many people, even Americans with insurance, don’t know they are eligible for preventive cancer screenings, for example, or have a screening but don’t receive adequate follow-up, she said. That’s a missed opportunity to get ahead of serious chronic conditions.

“Even within the same finite amount of healthcare resources, we’re not doing the best job possible,” Ma said. Money could be used more efficiently if the U.S. focused on disease prevention and primary care, especially for people at highest risk of developing chronic illnesses, she said.

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