PRB

Young adults are generally very healthy. In a recent survey, 96 percent of 18-to-24-year-old Americans reported being in excellent, very good, or good health. Less than 5 percent reported a serious physical, mental, or emotional disability.¹ Yet the transition from adolescence and dependence on parents to independent young adulthood is fraught with potential health dangers—and mortality statistics reflect these hazards.

Several factors make the 20s hazardous years for young Americans: This is the age of considerable risk-taking, as well as being the time when many young adults lose their financial and institutional safety net. Although schools and communities help nurture and protect children and adolescents, the responsibility of these institutions often ends when a teenager reaches age 18. These are also the years when young people begin to withdraw from the protective sphere of their parents. Americans in their 20s are the age group least likely to have health insurance: They generally no longer qualify under their parents’ policies and do not hold jobs with health insurance benefits.

Death Rates for Americans Ages 20-29 by Race/Ethnicity, 2007

Deaths per 100,000

Sources: National Center for Health Statistics, National Vital Statistics System, accessed at www.cdc.gov/nchs/, on June 7, 2010; and Jiaquan Xu et al.,” Deaths: Final Data for 2007,” National Vital Statistics Reports 58, no. 19 (May 2010); and Vintage 2007 Bridged-Race Postcensal Population Estimates, accessed at www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm#vintage2007, on June 30, 2010.

Injury and Violence Cause Most Deaths

The three leading causes of death for Americans in their 20s are tied to risky behavior and are largely preventable: accidents (unintentional injuries), homicide, and suicide. Together, these three causes accounted for 69 percent of the 42,000 deaths in this age group in 2007.² Cancer and heart disease are the fourth and fifth most common causes, accounting for another 10 percent of deaths. Although they have lower overall death rates, American teenagers are also highly vulnerable to these injury- and violence-related deaths for some of the same reasons.³ In contrast, injuries and violence are responsible for less than 10 percent of the deaths of Americans of all ages, while heart disease, cancer, and stroke account for just over one-half of all deaths.

It is not surprising that 20-somethings are more likely to die from injuries than from diseases that take years to develop, but a look at the large differences in injury mortality by sex and race/ethnicity underscores the fact that most deaths to young adults result from tragic events that should not have happened.

Men are more likely than women to die in any age group, and the difference is especially stark in the 20s (see figure). The death rate is more than two and one-half times higher for men than women among non-Hispanic whites and about three times higher for young men among Hispanics and non-Hispanic blacks. These disparities are clearly linked to why these young people die.

In general, women succumb to the same five leading causes as men in this age group, although in a slightly different order. African American women are the exception—HIV is their fifth-leading cause of death, and suicide the seventh-leading cause, after pregnancy-related complications. The magnitude of the differences for deaths from injury and violence is striking, both among men and women and among race and ethnic groups. Although the rate is much higher among young men, accidents (primarily automobile-related) are the leading cause for nearly all major groups of young people. Among black men in their 20s, however, accidents rank second to homicide (see table). Suicide is most prevalent among non-Hispanic whites, while homicide is most common among among blacks.

Five Leading Causes of Death for Americans Ages 20-29 by Race/Ethnicity, 2007
(Deaths per 100,000)

*Suicide ranks seventh for young black women, after HIV and complications from pregnancy.
**HIV is the fifth-leading cause for young black women, the sixth for young Hispanic and black men, and the eighth for young Hispanic women. It is not among the 10 leading causes of death among white non-Hispanics.
— The rate is not given because HIV was not among the five leading causes for this group.

Sources: U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, and National Injury Prevention and Control Center.

Cancer and Heart Disease Also Leading Causes

Unlike the injury-related causes, the death rates for cancer are about the same for men and women in each of the three racial and ethnic groups. There is also less variation in the death rate from heart disease, although the rate is higher among young blacks, especially black men.

The risk of getting and dying from cancer is much lower in this age group than for older adults, but while cancer death rates have been declining for older Americans, that has not been the case among young adults.⁴

Heart disease is a much greater health problem among blacks than whites in general, and this is apparent even at these younger ages. Although the reasons for higher rates among African Americans are not clear, some explanations focus on their higher rates of hypertension and lower likelihood of receiving preventive medical care.⁵

Preventing Injury and Violence

How could deaths to young adults be prevented? There are proven public health measures that can reduce injury mortality, and there have been great strides in preventing injury deaths from some causes. For example, the mortality rate from vehicle-related crashes has dropped since the 1970s—even as the number of cars on the road has increased—because cars and highways are safer.⁶ The increased use of seat belts, the increased presence of air bags, and stricter enforcement of drunk driving and motorcycle helmet laws have also worked to prevent thousands of deaths. And faster and improved emergency medical response teams save lives every day from injury—both intentional (including self-inflicted) and unintentional (accidental).

Yet despite such safety improvements, motor-vehicle crashes kill thousands of young Americans every year, and many more suffer crash-related disabilities. The efforts to reduce vehicle-related injuries require training and educating each new generation of drivers. Also necessary are continued advances in vehicle safety, enforcement of safe driving laws, and other prevention strategies.

Many injury-related deaths—whether from motor vehicles crashes or from other preventable events such as poisonings, falls, or drowning—arise from risky behavior and often involve alcohol or drugs. The risk of death related to substance abuse is greatest in the late teens and early 20s, and begins to subside as young adults enter their 30s. Indeed, preventing abuse of drugs and alcohol is very important in reducing death and disability from injuries.⁷ As for violence and suicide, avoiding deaths from these causes requires a broad-based response involving many aspects of society, including tackling such difficult issues as mental health, alcohol and drug use, and poverty.⁸

References

1. M. Jane Park et al., “The Health Status of Young Adults in the United States,” Journal of Adolescent Health 39 (2006): 305-17.
2. Jiaquan Xu et al., “Deaths: Final Data for 2007,” National Vital Statistics Reports 58, no. 19 (May 2010); and National Center for Injury Prevention and Control, data accessed at http://webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html, on June 30, 2010.
3. Arialdi M. Miniño, “Mortality Among Teenagers Aged 12-19 Years: United States, 1999-2006,” NCHS Data Brief, no. 37 (2010), accessed at www.cdc.gov/nchs/data/databriefs/db37.htm#source, on May 20, 2010.
4. Archie Bleyer and Ronald Barr, “Highlights and Challenges,” in Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age, Including SEER Incidence and Survival: 1975-2000, ed. Archie Bleyer et al. (Bethesda, MD: National Cancer Institute, 2006), accessed at http://seer.cancer.gov/publications/aya/15_highlights.pdf, on June 8, 2010.
5. Kirsten Bibbins-Domingo et al., “Racial Differences in Incident Heart Failure Among Young Adults,” New England Journal of Medicine 360, no. 12 (2009): 1179-90.
6. “Motor Vehicle-Related Death Rates—United States, 1999-2005,” MMWR Weekly 58, no. 7 (2009): 161-65; and National Highway Safety Administration, National Statistics, Motor Vehicle Traffic Crashes, accessed at www-fars.nhtsa.dot.gov/Main/index.aspx, on June 9, 2010.
7. National Center for Injury Prevention and Control, www.cdc.gov/injury/index.html.
8. National Center for Injury Prevention and Control, www.cdc.gov/injury/index.html.