Global Disparities in Premature Mortality.

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.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).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.The primary outcomes were PPD and the number of years behind the lowest country-level PPD.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).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.

Duke Scholars

Author Wenhui Mao Duke Global Health Institute

Author Gavin Mark Yamey Duke Global Health Institute