{"doi":"10.1007/s10680-025-09749-3","title":"Multi-Morbidity at Death and the US Disadvantage in Mortality","abstract":"The US experiences significant excess mortality compared to peer countries. The literature indicates that a similar disadvantage affects morbidity and, more generally, the prevalence of risk factors for major diseases within the US population. In this study, we assess the impact of multi-morbidity at death on the mortality gap between the US and three other high-income countries with comparable data, namely France, Italy, and Spain. The study relies on an analysis of the multiple cause-of-death information available on all death certificates for 2017, used to classify morbid processes leading to death into three categories: simple, multi-morbid, and ill-defined. The results show disproportionately high rates of multi-morbid processes in the US compared with the other three countries. Multi-morbid processes contribute 51% of the US gap in life expectancy at birth with Italy, 73% with Spain, and 75% with France, with a particular concentration at ages 20-85 years. The prevalence of multi-morbid processes in the US is consistent with the hypothesis that multiple factors, rather than a single culprit, are at play in the disadvantage in mortality and it could explain, at least in part, the extraordinarily high cost of health care in this country.","journal":"European Journal of Population / Revue européenne de Démographie","year":2025,"id":547901,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9538,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1115612,"name":"Aline Désesquelles","orcid":"0000-0001-5212-6746","position":1,"is_corresponding":false},{"id":1101706,"name":"Viviana Egidi","orcid":"0000-0001-9264-5882","position":2,"is_corresponding":false},{"id":1115608,"name":"Luisa Frova","orcid":"0000-0002-4594-1125","position":3,"is_corresponding":false},{"id":1115609,"name":"Francesco Grippo","orcid":"0000-0001-5471-8964","position":4,"is_corresponding":false},{"id":1115610,"name":"France Meslé","orcid":"0000-0001-6202-8955","position":5,"is_corresponding":false},{"id":1115611,"name":"Marilena Pappagallo","orcid":"0000-0003-0655-4541","position":6,"is_corresponding":false},{"id":295204,"name":"Sergi Trias‐Llimós","orcid":"0000-0002-8052-6736","position":7,"is_corresponding":false},{"id":660107,"name":"Magali Barbiéri","orcid":"0000-0003-3501-4034","position":0,"is_corresponding":true}],"reference_count":47,"raw_metadata":null,"created_at":"2026-07-19T02:53:53.962932Z","pmid":"41128928","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}