United States of America
The Health in the Americas+ country profiles are based on the interagency indicators available as of the dates referenced. The sources are referenced in this table. In some cases, the values of the indicators may differ from the most recent data available in the country.
Environmental and social determinants of health
In 2000, the total population of the United States of America was 282 398 554 inhabitants; by 2021 this figure had risen to 336 997 624, representing a 19.3% increase. Regarding the country's demographic profile, in 2021 people over 65 years of age accounted for 16.7% of the total population, an increase of 4,4 percentage points compared to the year 2000. In 2021, there were 101,9 women per 100 men and 91,4 older people (65 years or older) per 100 children under 15 years of age, as can be seen in the country's population pyramids, distributed by age group and sex (Figure 1). Considering the population between 15 and 64 years of age to be potentially active (i.e., potential participants in the labor force), this group represented 65,1% of the total population of the country in 2021(219 311 549 people). When these figures are added to the potentially passive population (61 478 594 under 15 years of age and 56 207 482 over 65 years of age), the result is a dependency ratio of 53,7 potentially passive people per 100 potentially active people. This ratio was 50,9 in 2000.
Life expectancy at birth was 79 years in 2021—higher than the average for the Region of the Americas and 2.9 years higher than in 2000.
Figure 1. Population pyramids of the United States of America, years 2000 and 2021
Between 2004 and 2020, the average number of years of schooling in the United States increased by 6.7%, reaching an average of 13.7 years in the latest year for which information is available. The unemployment rate in 2019 was 3.7% for the total population. Disaggregated by sex, the rate was 3.61% for women and 3.72% for men. The literacy rate was 79% in 2013 among adults aged 16–65 who have English literacy skills at a level 2 or above in the Program for the International Assessment of Adult Competencies from the Organisation for Economic Co-operation and Development. In addition, 11.4% of the population was below the national poverty line in 2020, an increase from 10.5% in 2019. In 2019, 1% of the population was living in poverty, defined as the percentage of the population with an income of less than US$ 1.90 per day; this is below the regional average of 3%.
During the period 2000–2019, the country improved its score on the Human Development Index, with an increase of 4.5% from a score of 0.886 to a score of 0.926; during the same period, the index rose 15% internationally and 11% in Latin America (Figure 2).
Figure 2. Human Development Index in the Region of the Americas, 2021
In 2018, public expenditure on health accounted for 8.5% of gross domestic product (GDP) (Figure 3) and 16.9% of total public expenditure, while out-of-pocket spending on health accounted for 10.8% of total health expenditure.
Figure 3. Public expenditure on health as a percentage of gross domestic product in the Region of the Americas, 2019
In 2019, 89.4% of people in the United States had an Internet connection, representing a considerable increase from 2000, when 43.1% of the population had an Internet connection.
Maternal and child health
Between 2000 and 2019, infant mortality in the United States decreased from 6.9 to 5.6 deaths per 1000 live births, a decrease of 18.8% (Figure 4). The percentage of low-weight births (less than 2500 g) increased from 7.6% to 8.3% between 2000 and 2019, while exclusive breastfeeding in the child population up to 6 months of age was 26.4% in 2014, compared with 23.3% in 2009.
Regarding the immunization strategy, measles vaccination coverage was 90% in 2019, a decrease of 1 percentage point over 2000.
The maternal mortality ratio for 2017 was estimated at 19 deaths per 100 000 live births, an increase of 58.3% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that women have an average of 1.8 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 66.8% decrease, from 47.9 live births per 1000 women aged 15 to 19 years in 2000 to 15.9 in 2021. Between 2000 and 2019, the percentage of pregnant people who received antenatal care increased from 92.1% to 95.8%. In 2016, 99.1% of births were attended by skilled birth personnel.
Figure 4. Infant mortality per 1000 live births, 1995–2020
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Figure 5. Maternal mortality per 100 000 live births, 2000–2017
In 2019, there were 2.6 new cases of tuberculosis per 100 000 population in the United States. In the same year, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 0.1 (0.1 in women and 0.1 in men).
In 2019, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 10.9 per 100 000 population. The age-adjusted mortality rate for HIV was 1.4 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 71.4%.
There were no cases of human rabies in the country in 2020.
Noncommunicable diseases and risk factors
In the United States of America, the prevalence of tobacco use among people aged 15 and older was 19.7% in 2019. In the same age group, the prevalence of overweight and obesity was 67.9% in 2016.
Also in 2016, 40% of the population reported insufficient physical activity.
In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 12.9%, a decrease of 2.4 percentage points compared to 2000 (15.3%). The prevalence of diabetes mellitus, which stood at 6.3% in 2000, increased to 7.3% in 2014.
In 2019, the adjusted rate of potentially avoidable premature mortality in the United States was 203.1 deaths per 100 000 population, a decrease of 14.7% from a rate of 238.2 in 2000. This meant that, in 2019, the rate in the country was 10.4% lower than the average rate reported for the Region of the Americas as a whole. Among potentially avoidable premature mortality, the rate for preventable causes was 134.2 per 100 000 population in 2019, which is 2.1% lower than the regional average rate; and the rate for treatable causes was 68.9 per 100 000 population, below the regional average of 89.6.
The overall age-adjusted mortality rate was 4.8 per 1000 population in 2019, a decrease of 14.3% compared to 2000 (5.6 deaths per 1000 population).
When deaths are categorized into three main groups, it is observed that, in 2019, the age-adjusted mortality rate from communicable diseases was 28,9 per 100 000 population (31.4 per 100 000 in men and 25.9 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 417,2 per 100 000 population (475.8 per 100 000 in men and 348.5 per 100 000 in women). The rate of age-adjusted mortality from external causes was 46,3 per 100 000 population (66.9 per 100 000 in men and 25.4 per 100 000 in women), including road traffic accidents (11.1 per 100 000 population), homicides (6 per 100 000 population), and suicides (14.5 per 100 000 population). In 2000, the percentage distribution of causes was 87,9% for noncommunicable diseases, 6,3% for communicable diseases, and 5,8% for external causes; in 2019, the percentages were 88,1%, 5,3%, and 6,6%, respectively (Figure 6).
Figure 6. Proportional mortality in the United States of America, 2000 and 2019
Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 11.6 per 100 000 men; lung cancer, 30.2 per 100 000; and colorectal cancer, 12 per 100 000. In women, these values were 15.9 deaths per 100 000 for breast cancer, 21.7 per 100 000 for lung cancer, and 8.8 per 100 000 for colorectal cancer.
The health situation and the COVID-19 pandemic
In 2020, the United States ranked the 4th in the Region of the Americas in terms of the number of deaths from COVID-19, and 14th in 2021, with a cumulative 2 434 deaths per million population over the two years (Figure 7). According to estimates by the World Health Organization, there was a total of 465 707 excess deaths in 2020, or 141 per 100 000 population; a total of 466,753 deaths were estimated in 2021, for an excess mortality rate of 140 per 100 000.
As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 61.1% of the country's population. As of 20 April 2022 (latest available data), 66% of the population had completed the vaccination schedule. The vaccination campaign began on 20 December 2020, and three types of COVID-19 vaccine have been used to date.
Figure 7. Cumulative COVID-19 deaths in the Region of the Americas, to 31 December 2022
Over the next five years, the process of population aging is expected to continue. In this regard, the United States will have to continue adapting its healthcare system to be able to respond to the challenges that this demographic process implies, including policies for the attention and care of older persons. The problems of system sustainability and high public spending will be permanently on the agenda.
Beyond the high socioeconomic development achieved by the country, one of the pending challenges at the health level is the achievement of equity in terms of health coverage and distribution of available resources.
Regarding the response to the COVID-19 pandemic, the vaccination strategy will continue to be promoted, optimizing the coverage of complete vaccination schedules and reinforcing access to booster doses. One of the obstacles to be faced will be the rejection of immunization by some sectors of the population, which will require redoubling efforts in the area of social communication, possibly supplementing these promotional initiatives with measures restricting circulation or access to certain sites for people who cannot prove that they have been vaccinated.
In the area of infant health, mortality indicators continue to decline favorably. The proportion of under-five mortality attributable to acute diarrheal disease is striking in the context of a highly developed country.
The sustained increase in maternal mortality over the last two decades is serious and notorious. The country should address this problem by promoting universal access to health care for its population, especially for the most vulnerable and unprotected sectors of the population.
The weight of chronic diseases in mortality as a percentage of all causes is characteristic of countries with a higher level of development. The increase in obesity and diabetes in recent years should be slowed down through the design of public policies aimed at promoting healthy eating across the board in all age groups. The prevalence of smoking remains high and will contribute significantly to the burden of cardiovascular disease and cancer in the coming years.
Communicable diseases such as tuberculosis and HIV show downward trends in incidence, as does specific mortality due to these pathologies. External causes are close to duplicating communicable diseases in their impact on mortality, and require a comprehensive approach to contain and reduce them, with particular emphasis on the problem of suicide. Another mental health issue that should be on the health agenda is the problematic use of psychoactive substances, including, among others, opioids and heroin.
The sources of the interagency indicators used in this profile can be found in this table.
For the latest data on health indicators for the Region of the Americas, be sure to visit the PAHO Core Indicators portal.