BOSTON, April 24, 2026 – At every age, children in the United States die at higher rates than peers in other high-income nations, according to a new study from Children’s Hospital of Philadelphia. Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2026 Meeting , taking place April 24-27 in Boston.
The study found that the U.S. mortality disadvantage emerged as early as 1952 among older adolescents and has persisted for more than five decades. While both the U.S. and peer nations made dramatic gains over the 20th century, peer nations improved at a faster pace — particularly in the postwar decades. By 2023, the gap was largest among 15- to 19-year-olds, with males in that age group accounting for nearly one-third of excess U.S. child deaths. Between 1975 and 2023, the U.S. experienced approximately 800,000 excess child deaths compared to peer nations — equivalent to roughly 45 excess child deaths every day. Findings point to adolescent injury, violence, and self-harm prevention, as well as maternal and infant health supports, as high-priority policy targets.
“We found that the U.S. child mortality disadvantage has persisted for decades and is now increasingly concentrated among older adolescents, particularly males,” said Lauren J. Koenigsberg, program manager at Children’s Hospital of Philadelphia and lead author of the study. “These findings highlight an urgent need to address preventable causes of death—especially injury, violence and self-harm—where the U.S. continues to lag behind peer nations.”
Children’s Hospital of Philadelphia previously reported that childhood mortality in the United States is 80% higher than in 18 peer nations in the Organization for Economic Co-operation and Development (OECD18) (Forrest et al, JAMA, 2025). The current study extends that work by examining when this gap first emerged, how durable it has been across nearly nine decades, and which age and sex groups have contributed most.
Additional information is included in the below research abstract. The PAS Meeting connects thousands of leading pediatric researchers, clinicians and educators worldwide. View the full schedule in the PAS 2026 program guide . For more information about the PAS Meeting, please visit www.pas-meeting.org .
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About the Pediatric Academic Societies (PAS) Meeting
The Pediatric Academic Societies (PAS) Meeting connects thousands of leading pediatric researchers, clinicians, and educators worldwide, united by a shared mission: connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health. PAS is a partnership of four premier pediatric associations: the American Academy of Pediatrics (AAP) , the Academic Pediatric Association (APA) , the American Pediatric Society (APS), and the Society for Pediatric Research (SPR) . For more information, visit www.pas-meeting.org . Follow us on X , Facebook, and Instagram .
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Abstract: Child and Adolescent All-Cause Mortality in the United States Versus Peer Nations, 1935–2023
Presenting Author
Lauren J. Koenigsberg, Program Manager, Children’s Hospital of Philadelphia
Organization
Children's Hospital of Philadelphia
Topic
General Pediatrics: All Areas
Background
Children in the United States (US) experience higher all-cause mortality than peers in high-income nations in the Organisation for Economic Co-operation and Development (Forrest et al, JAMA, 2025), but the timing of this divergence, its durability across decades, and which age and sex groups contributed most to the gap have not been characterized.
Objective
To characterize the timing, persistence, and age- and sex-specific patterns of the US child and adolescent mortality disadvantage relative to peer nations.
Design/Methods
Time-series comparison using vital statistics from the Human Mortality Database (1935–2023), comparing all-cause mortality among 0- to 19-year-old individuals in the US versus those living in 13 high-income peer nations from the Organisation for Economic Co-operation and Development (OECD13). We estimated mortality rates, rate ratios, annual percent change, and annual excess US deaths.
Results
All-cause mortality declined 89.0% in the US (477.6 to 52.4 per 100,000) from 1935 to 2023, compared with 96.6% in OECD13 (785.1 to 26.9 per 100,000). US mortality crossed over OECD13 in 1975 and remained higher thereafter. By 2023, the US disadvantage was largest among 15- to 19-year-old individuals (rate ratio 2.9). From 2006 to 2023, annual percent change was −1.2% (95% CI −1.7% to −0.6%) in the US versus −2.3% (95% CI −2.7% to −2.0%) in OECD13. In 2023, those aged 15- to 19-years-old accounted for 40.4% of excess deaths, with males contributing 30.6%.
Conclusion(s)
The U.S. child and adolescent mortality disadvantage is not a recent phenomenon — it dates to the mid-1970s and has persisted for five decades. Today, the gap is most pronounced among older adolescent males, consistent with higher U.S. rates of injury, violence, and self-harm. Addressing these preventable causes of death, alongside strengthening maternal and infant health supports, represents the clearest path to closing the gap with peer nations.
Co-Authors
Christopher B. Forrest, MD, PhD, Professor of Pediatrics, Children's Hospital of Philadelphia
Mari K. Noble, Clinical Research Assistant, Children's Hospital of Philadelphia
Mitchell Maltenfort, PhD, Children's Hospital of Philadelphia
Neal Halfon, MD, MPH, founding director of the University of California, Los Angeles (UCLA) Center for Healthier Children, Families & Communities