ArticleInternational journal of epidemiology2026
Sicker at all ages? Two decades of changing disease histories and mortality in the United States.
Article in International journal of epidemiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStagnating cardiovascular disease mortality and rising drug- and suicide-related deaths are key drivers of stalled US mortality improvements. However, prior research has largely overlooked disease histories preceding death, despite increasing multimorbidity. We examined changes in disease-history profiles in the US population and assessed how shifts in profile composition and within-profile mortality shaped mortality trends.
methodsWe analysed adults aged ≥30 years (N = 510 372) from the IPUMS-NHIS (National Health Interview Survey) 1997-2018 linked mortality files (follow-up through 2019). Latent class analysis on the pooled sample across all ages and years identified disease-history profiles based on self-reported cancer, diabetes, cardiovascular disease, mental health, internal diseases, obesity, and physical limitations. Logistic regression was used to estimate profile-specific 5-year mortality over time, and counterfactual decomposition was used to quantify the contributions of compositional change and within-profile mortality improvement to overall mortality trends.
resultsFive disease-history profiles were identified. Prevalence and 5-year death probability ranged from disease-free (62.4%; men 3.7% [95% confidence interval (CI) 3.5-3.8], women 2.4% [95% CI 2.3-2.5]) to high-burden multimorbidity (5.9%; men 17.8% [95% CI 16.8-18.8], women 12.6% [95% CI 11.9-13.3]), with substantial gradients across intermediate profiles. Profile composition varied substantially by gender, education, and race/ethnicity. The disease-free population declined by nearly 1% annually, replaced primarily by cardiometabolic and high-burden multimorbidity profiles. Most profiles experienced stagnating or increasing mortality after the mid-2000s. The decomposition shows that within-profile mortality improvement was the dominant driver of declining mortality; compositional shifts, mostly driven by the declining disease-free share, partially offset these gains.
conclusionStagnating US mortality reflects both the growing prevalence of high-morbidity profiles and worsening or stagnating survival within them, highlighting the limited reach of prevention and disease-management efforts.
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