tourist death rates by country

The 50 Most (& Least) Deadly Travel Destinations

Published on December 1, 2022 by Matthew H. Nash

One crucial factor when planning an international trip is safety. From homicide rates to natural disaster risk, some countries pose a greater threat to safety than others. Our research team crunched numbers on seven safety risk factors for 50 of the most-visited countries to create our “Travel Safety Index” .

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Ranking Factors

The 50 countries included in our study were selected based on how popular they are among tourists. To determine the deadliest places in the world for tourists, we looked at the following ranking factors:

Please note: Due to ongoing conflicts in the region, Russia and Ukraine were omitted from the study.

1. Homicide Rate (0-100 points) – The number of intentional homicides per 100,000 people.

Source: United Nations Office on Drugs and Crime

2. Road Traffic Death Rate (0-100 points) – The estimated road traffic death rate per 100,000 people.

Source: World Health Organization

3. Poisoning Death Rate (0-100 points) –  The mortality rate attributed to unintentional poisonings per 100,000 people.

4. Unsanitary Conditions Mortality Rate (0-100 points) – The mortality rate that is attributed to unsafe sanitation, unsafe water, and a lack of proper hygiene per 100,000 people.

Source: World Bank

5. Life Years Lost Due to Communicable Diseases (0-100 points) – The number of life years lost due to infectious diseases (adjusted for disabilities) per 100,000 people.

Source: Our World in Data

6. Life Years Lost Due to Injury (0-100 points) – Age-standardized and disability-adjusted life years lost due to injuries (including conflict, violence, and self-harm) per 100,000 people.

7. Natural Disaster Risk (0-50 points) – An index created by the German non-profit Bündnis Entwicklung Hilft in partnership with the United Nations University Institute for Environment and Human Security, the World Risk Report scores countries based on the risk of a natural disaster such as earthquakes, floods, or cyclones as well as the ability of the country to handle a disaster should it occur.

Source: WorldRiskReport

Study Limitations

An individual’s exposure to risk while traveling largely depends on the type of travel they choose and which areas of a country they visit. For example, going to a destination and staying in an all-inclusive luxury resort will often carry significantly less risk of bodily harm than staying in an area known for high crime, injury, or natural disasters. It’s impossible to account for every variable that a traveler may experience when analyzing countries as a whole. This study attempts to aggregate data taking into account a variety of factors to determine a nations overall risk profile.

Where Are the Most Dangerous Places to Travel?

Below are the 20 deadliest travel destinations:

• South Africa
• Dominican Republic
• Philippines
• Saudi Arabia
• United States

#1 Most Deadly Country: South Africa

South Africa is a beautiful and exceptionally biodiverse country that attract millions of international tourist each year. However, it also tops the list of the most deadly countries for tourists. Out of the 50 countries studied, South Africa has the highest homicide rate (36.40 per 100,000 people) and the highest number of life years lost due to communicable diseases (23,778 years per 100,000 people). The country also has the sixth-highest road traffic death rate (22.22 per 100,000 people).

South Africa scored an F in six of the seven factors used in our research study. The U.S. Department of State indicates:

“Violent crime, such as armed robbery, rape, carjacking, mugging, and ‘smash-and-grab’ attacks on vehicles, is common. There is a higher risk of violent crime in the central business districts of major cities after dark.

Demonstrations, protests, and strikes occur frequently. These can develop quickly without prior notification, often interrupting traffic, transportation, and other services; such events have the potential to turn violent.”

Why is South Africa so unsafe?

Approximately 68 people are murdered in South Africa every day. Why this occurs is a complicated question to answer, but many believe it boils down to the following reasons:

• Poverty and income inequality
• High amounts of gang violence and organized crime
• Weak, slow judicial system

Other factors like the prevalence of easy access to firearms, alcohol abuse, unemployment, and corruption have also been cited as causes for the extremely dangerous crime and hazardous living conditions within South Africa.

#2 Most Deadly Country: India

India is second on the list of most deadly countries for tourists. While the country has a relatively low homicide rate and poisoning death rate, they are the top country for deaths from poor hygiene conditions, at 18.6 per 100,000 people.

Not only is India extremely populated, but it is also has extreme income inequality, with a massive gap between the country’s richest and poorest citizens. This wealth gap means that many of India’s over 1.3 billion people live in poverty and dangerous living conditions, with an estimated 60% of its citizens surviving on little over $3 a day.

Shoddy infrastructure, substandard health, and sanitation conditions are just some of the issues that Indians face on a daily basis, with the lowest classes being forced to navigate the worst of it.

Most and least deadly by category

South Africa has the most documented incidents of homicide by a relatively large margin, with 36.4 homicides per 100,000. Mexico, the country with the second highest homicide rate, has 29.1 homicides per 100,000, and Brazil has 27.4 homicides per 100,000. The homicide rate drops significantly from there, with the remaining countries reporting 10.00 or fewer per 100,000. Notably, the US has the 7th highest rate of homicide when compared to these 50 countries.

The countries with the highest homicide death rates are:

Road Deaths

Vehicle transportation is unavoidable for most travelers, and unsafe road conditions can provide a considerable safety hazard in many countries. According to the CDC , 1.35 million people globally are killed in motor vehicle accidents every year, making this a real danger and a serious consideration when traveling to countries with more lax driving laws and poorly maintained infrastructure.

The Dominican Republic has a road death every two hours, which accounts for a significant portion of Dominican Republic deaths per year. Reasons for the dangerous road conditions are attributed to “a lethal mix of alcohol, speed and blatant disregard for traffic laws,” according to The San Diego Union-Tribune.

The countries with the highest road traffic death rates are:

Poisoning Deaths

Romania, China, and South Africa are all outliers when it comes to poisoning deaths. According one study by the NIH , China had 16,179 unintentional poisoning deaths in 2016 which made up 31% of the world’s total of 52,077 poisoning deaths that year. The details and causes of poisoning incidents in China is scattered which suggests these numbers may be underreported.

The countries with the highest poisoning death rates are:

Mortality Rate from Unsanitary Conditions

Anyone who has had traveler’s diarrhea or another food-borne illness will know how vital sanitation is when it comes to a vacation. There are ways to prevent illness from unsanitary conditions, but it’s not entirely possible to eradicate the threat of sickness in all regions.

While India is a developing country and is modernizing quickly, there’s still much progress to be made in terms of general hygiene. An estimated one in ten deaths in India is attributed to poor hygiene conditions. Similarly, South Africa is having significant issues with clean water access and available sanitation services for its citizens, though this does appear to be improving.

The countries with the highest death rates from poor hygiene:

• South Korea

Communicable Disease Deaths

Covid-19 has shown us that infectious diseases are extremely serious, but many other diseases around the world also have devastating impacts and cause countless deaths every year. These include diseases like dengue fever, malaria, measles, cholera, typhoid, yellow fever, and more. It’s always a good idea to check with your medical provider before traveling to a new region because they will have data available to ensure you are immunized against local diseases as much as possible and can take other preventative measures such as wearing insect repellant.

South Africa has over double the number of life years lost due to communicable diseases as India. Some of the diseases affecting South Africans include HIV, tuberculosis, respiratory infections, and more, according to the CDC.

The countries with the highest number of years lost from communicable diseases:

Life Years Lost to Injury

Injury in life is inevitable. You can’t prevent a broken arm or a sprained ankle anywhere in the world, but some regions are more prone to accidents or injury. This can be for various reasons, including infrastructure problems, inaccessible walkways, poorly maintained hiking paths, and much more.

South Africa has the highest years of life lost due to injuries, with many of those injuries coming from interpersonal violence and road traffic incidents. Saudi Arabia likewise reports many injuries, with most reported injuries affecting young males. These injuries were largely traffic-related.

The countries with the highest number of life years lost to injury are:

• United Arab Emirates

World Risk Index

Natural disasters are increasingly becoming a regular part of our modern life due to the impacts of climate change , and it would be unwise to fail to consider the likelihood of natural disasters when picking a travel destination. Not only should the location be factored in, but also the season. For example, many counties have significant and deadly monsoon and hurricane seasons, which can threaten tourists and locals alike.

The most dangerous country when it comes to natural disaster risk and readiness response is the Philippines, according to the annual World Risk Index. The Philippines garnered a score of 46.8. The second and third most dangerous countries are India and Indonesia, followed by Mexico and China. Notably the US and Australia ranked 7th and 8th respectively.

The countries with the highest natural disaster risk:

What Are the Safest Countries for Tourists to Visit?

Based on data for 50 of the most-visited countries in the world, these are the fifteen safest countries for tourists and their Travel Safety Index scores:

• Netherlands
• Switzerland
• United Kingdom
• Czech Republic

#1 Safest Country: Singapore

According to our index, Singapore is the least deadly country for tourists. With a very low homicide rate, road death rate, and natural disaster risk, Singapore is an excellent choice for travelers in terms of safety.

What makes Singapore so safe? Well, crime does not pay in Singapore. The consequences for committing crimes in Singapore are incredibly high, even for “smaller” crimes. This, combined with high surveillance and police presence, makes Singapore the world’s safest country for travel.

This, of course, doesn’t mean you shouldn’t still take universal safety precautions, even in Singapore. For some top travel safety tips, see the end of the article.

#2 Safest Country: Denmark

Denmark’s high safety ranking likely won’t come as a surprise to those familiar with Denmark’s reputation. The low crime rate is often attributed to strong social safety nets that keep its citizens out of poverty, which decreases petty crimes like theft and pickpocketing. Denmark also has a robust police presence, a (relatively) transparent government, and high-quality technological surveillance, which makes Denmark an uncommonly safe place to live and travel.

This level of safety and community trust made Denmark go viral recently when people on social media discovered footage of Danish mothers and fathers leaving their newborns outside to sleep in their strollers while the parents go into shops and cafés. This is a common practice and is often believed to help babies and infants sleep comfortably and develop better immune systems. The idea of trusting the general public with an infant seems like madness in many other parts of the world. This goes to show the level of safety and transparency within Denmark.

Tips for staying safe while traveling, no matter the destination

• Never travel without doing your research – Each destination, from the most to the least deadly, will have its share of challenges and hurdles. Looking up common scams in your destination city or country will help you stay sharp and mindful of dangerous tactics.
• Check the natural disaster risk for your region – Many places around the world, from Louisiana to Mumbai, are more prone to natural disasters at certain times of the year. Knowing if your destination is experiencing monsoon season, hurricane season, extreme heat or cold, and other potentially dangerous natural disasters will keep you and your family stay safe and help you avoid potentially high-risk areas.
• Practice universal safety precautions – Just because you might be in a “safe” country, don’t let your guard down. Crime, unsanitary conditions, and injuries can happen anywhere, and tourists are often targeted everywhere in the world.
• Invest in high-quality safety travel gear – Things like RFID neck wallets, money belts, and sturdy luggage locks will help keep you and your family’s items safe around pickpockets.
• Register your trip with your local embassy – Your government having a way to find you and help remove you from a dangerous situation is incredibly important. If you plan to travel internationally, see if your country has a way to report your trip before embarking on your adventure. The United States has STEP (Smart Traveler Enrollment Program), Canada has Registration of Canadians Abroad, and other countries have equivalent programs for their citizens.
• Save your embassy’s information – Speaking of embassies, know your country’s embassy information before traveling internationally. Whether you write down the embassy phone number and address on a piece of paper or add it to your phone’s cloud service, having a way to access your country’s representative embassy while traveling abroad could be lifesaving in the event of an emergency.
• Travel with a friend or family member – Solo travel can be a fun, freeing activity. But it can also open you up to more potential risks. Traveling with friends and family is often a safer alternative to solo travel.
• Don’t keep all of your cash in one place – Having all your funds in a central location could be disastrous should an emergency arise. If you get robbed, your wallet goes missing, or you get separated from the rest of your group, it’s essential to have emergency money to fall back on. Keeping extra cash in your phone case, in your shoe, or somewhere else inconspicuous may seem silly, but it could bail you out in a pinch.
• Be careful where you eat – Not all countries enforce strict sanitation standards regarding food and beverages. Check reviews, go to restaurants suggested by friends and family, and practice precautions when eating out (particularly when it comes to street food).
• Know the risks of your destination and travel accordingly – If, for example, you do some research and find that your destination may not have the safest water, you can bring a Grayl or filter bottle. Knowing what to expect by planning ahead can save money (and discomfort) during the trip.
• Have your medical information (securely) available – Nobody wants to think about the possibility of hospitalization or injury while on vacation, but it can and does happen. Memorizing your blood type, having a list of your medications and dosages, as well as any allergies and other pertinent medical info available for medical professionals to review is critical should an emergency arise.
• Hire a guide – While guides can’t reasonably protect you from all danger, they can use their local knowledge of the country to keep you safe. Many guides will provide translation services, ensure you eat in safe restaurants, and can help you avoid dangerous neighborhoods.
• Keep a family member or friend aware of your travel plans – Having a friend or family member back home know your travel itinerary could be incredibly helpful if something goes wrong.
• Listen to your intuition – If something doesn’t feel safe, seems too good to be true, or otherwise sets off “alarm bells” while traveling, trust your instincts and remove yourself if it is safe to do so.
• Always travel with insurance – You never know what can happen while traveling. Whether you’re traveling domestically or across the world, it’s always better to err on the side of caution. Travel insurance is often fairly inexpensive ( often costing less than $100 for a two-week trip ) and can save thousands in emergency expenses. See some of our guides here: Antartica , Belize , Costa Rica , Cruise , Dubai , and Europe .
• United Nations Office on Drugs and Crime
• World Health Organization
• Our World in Data
• WorldRiskReport
• CNN: Seeing the new India through the eyes of an invisible woman
• Business Tech: New data shows shocking rise in violent crime in South Africa
• CNET: India spent $30 billion to fix its broken sanitation. It ended up with more problems
• The Economist: Why it is so hard to fix India’s sanitation
• Borgen Project: 10 Facts about Sanitation in South Africa
• National Library of Medicine: The high burden of injuries in South Africa
• National Library of Medicine: Burden of traumatic injuries in Saudi Arabia

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Death Rate by Country 2024

The death rate, also known as mortality rate, is the number of the deaths that occur in a particular population during a particular period of time. Typically, death rate is expressed as the number of deaths per one thousand people per year. Countries with high mortality rates and relatively low fertility rates and birth rates face the risk of population decline. Death rates vary significantly between countries, and as a rule, developed countries , have a lower death rate than do developing countries , whose health care networks and facilities are less robust. In fact, many of the least developed countries may struggle to provide basic human needs such as potable water, adequate food, and sanitation, which increases the risk of disease and other health complications. On a global scale, total daily births outpace total daily deaths by a wide margin, though this is expected to decrease over the coming century.

Factors that influence a country's death rate

Proper diet and exercise, clean water, and quality health care are the factors that have the greatest impact on mortality rates. Diet and exercise are particularly important: According to the Global Health Data Exchange , cardiovascular disease—which is typically caused by obesity stemming from unhealthy eating habits—was the leading cause of death worldwide from 1990-2019. Diabetes, which is also diet-related, ranked 9th. While it would be reasonable to suspect that developed countries would also be the most obese countries and countries with the highest diabetes rates due to the abundance of processed and "junk" food, they actually tend to also be among the healthiest countries in the world thanks to their more advanced health care systems. That said, even the most modernized health care system has its limits. As such, cancer remains the second-leading cause of death in the world, especially in countries with high rates of smoking and/or alcoholism .

Mortality rates can also see temporary spikes due to less predictable causes of death. Particularly in countries at war or undergoing some other form of civil unrest, gun deaths can boost mortality rates. So can outbreaks of disease. For example, the COVID-19 pandemic is expected to create a significant spike in 2020-21 mortality data.

Top 10 Countries with the Highest Death Rates (per 1,000 people) — United Nations 2015-2020:

1. bulgaria.

Bulgaria has the highest mortality rate in the world at 15.4 deaths per 1,000 people. According to the World Health Organization , the causes of death in Bulgaria are similar to those in other European countries, including non-communicable diseases (diseases of the circulatory, digestive, or respiratory systems) and cancers. Bulgaria is currently experiencing a population decline, starting at about 9 million in 2000 and is expected to fall to between 2.8 million and 5 million.

Ukraine has the second-highest mortality rate of 15.2 deaths per 1,000 people. Ukraine is considered to be in a demographic crisis because of its high mortality rate and low birth rate. Overall, Ukraine's health care system is poorly financed, and the country has very low vaccination rates and high rates of diseases and disorders that could be better managed with increased funding. One factor contributing to the mortality rate is the high death rate of working-age males from preventable causes such as alcohol poisoning and smoking. Additionally, Ukraine has one of the fastest-growing HIV/AIDS epidemics globally and suffered one of the worst measles epidemics in the world in 2019.

Latvia's mortality rate is 14.6 per 1,000 people. Latvia also has an underfunded health care system. Although life expectancy has significantly improved in Latvia, the country still lags behind the rest of the European Union , driven by greater exposure to risk factors among men, people with low education, and people with low income. Those with low education levels in Latvia have a life expectancy that is ten years lower than those with high education. Some common risk factors among Latvians are smoking, binge drinking, and obesity.

With a mortality rate of 14.3 deaths per 1,000 people, Lesotho has the world's fourth-highest mortality rate. According to the CDC , the life expectancy at birth in Lesotho is 56 years for females and 52 years for males. The infant mortality rate is 59 per 1,000 live births. The leading causes of death are HIV/AIDS, tuberculosis, stroke, lower respiratory infections, and ischemic heart disease.

5. Lithuania

Lithuania's death rate is 13.737 deaths per 1,000. The World Health Organization reports that ischemic heart diseases and stroke are the two leading causes of death in Lithuania, with mortality rates four and two times above the average rates in the European Union respectively. Due to high smoking rates, lung cancer is now the third leading cause of death in Lithuania. Lithuania also has the lowest life expectancy in the EU of 74.8 years.

Serbia's death rate is 13.2 per 1,000, the sixth-highest in the world. According to a study, Serbia's mortality rate was lowest in the 1960s, where it was between 8 and 9 deaths per 1,000. During the beginning 21st century, the rate was much higher, reaching 14 deaths per 1,000 at its highest. Demographically, Serbia is one of the oldest nations in Europe , and its aging population has a large role in its death rate. Additionally, chronic non-communicable diseases and cardiovascular disease are the two leading causes of death. Serbia is also among the world's ten countries with the highest smoking rate.

Croatia's mortality rate is 13.1 deaths per 1,000 people. The leading causes of death in Croatia are ischemic heart disease, stroke, Alzheimer's, and lung cancer. About 25% of Croatian citizens smoke tobacco every day, higher than the EU average. Additionally, obesity rates are rising, especially in children, where the rate has grown more than 50% since 2001. While life expectancy has improved since 2000, rising from 74.6 to 78.3, it is still three years below the EU average.

Romania's death rate is the eighth-highest in the world at 13.0 deaths per 1,000. The leading causes of death in Romania are cardiovascular disease, malignant tumors, digestive diseases, accidents, injuries and poisonings, and respiratory diseases. Additionally, the infant mortality rate in Romania is the highest in the EU at about 8 per 1,000. This is often attributed to a shortage of doctors. About 43,000 doctors have left Romania since 2007 to look for opportunities elsewhere.

Georgia has a mortality rate of 12.8 deaths per 1,000. According to the World Health Organization , the leading causes of death are the same in most European nations: cancer, circulatory, respiratory, and digestive diseases, and injuries and poisoning. The premature mortality rate (for individuals under 65) has increased since 2000, with diseases of the circulatory system and cancers cited as the leading causes of death. Several risk factors for non-communicable diseases are common among the Georgian people, including smoking tobacco, alcohol use, and overweight/obesity. The highest risk factors associated with disease in Georgia are dietary risks, high blood pressure, high body mass index, and tobacco use.

Russia finishes the ten countries with the highest death rates with a death rate of 12.7 per 1,000. More than half of the deaths in Russia are caused by cardiovascular disease. The second-most-common cause of death is cancer, followed by suicide, road accidents, homicide, and alcohol poisoning. Alcohol abuse is a significant problem in Russia, especially for men. The life expectancy is 66.4 years for men and 77.2 years for women.

Top 10 Countries with the Lowest Death Rates (per 1,000 people) — United Nations 2015-2020:

Countries with low mortality rates have more advanced and accessible health care, better-informed citizens, healthier nutritional options, and higher living standards overall. Qatar has the lowest mortality rate in the world at 1.2 deaths per 1,000 people. This low mortality rate can be attributed to Qatar's improved health care system, renowned for its technologically advanced facilities and ability to deliver some of the world's best patient care.

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Which country has the highest death rate?

Which country has the lowest death rate, frequently asked questions.

• Global All-Cause Deaths 2019 - Global Health Data Exchange
• Crude Death Rate - United Nations Department of Economic and Social Affairs

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Sec. 204(c) of P.L. 107-228, the Foreign Relations Authorization Act for Fiscal Year 2003, says that, when possible, the Department of State must collect and post on the Department's Bureau of Consular Affairs Internet site certain details about each United States citizen who dies in a foreign country from a non-natural cause. It requires: (1) the date of death; (2) the place of death; and (3) the cause of death. If the death was due to terrorism, the report must say so. The web site must list the information by country. It must cover deaths in the preceding three calendar years. The information is updated every six months.

Deaths listed as “undetermined/unknown” have been reported to the Department of State as deaths from non-natural causes. Local authorities have not provided more information.

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The Most Dangerous Countries for Tourists, in Maps

The recent assaults in Brazil and India have raised questions about those countries' safety records. Here are the places where travelers should actually be wary.

It's been an alarming past few weeks for fans of international travel.

In March, a Swiss woman was gang-raped while she was camped out in a forest with her husband after a day of biking around the central Indian state of Madhya Pradesh. And on Monday, an American tourist was raped by three men over the course of six hours while aboard a public van near the seaside resort town of Copacabana .

The incidents have already taken their public-relations toll. The Brazil rape is the latest evidence that the country has a growing sexual assault problem -- reports of rapes there have risen 150 percent since 2009 -- and raises questions about Brazil's readiness for the 2014 World Cup and 2016 Olympic Games.

And in a new survey of 1,200 tour operations across India, the Associated Chambers of Commerce and Industry of India found that the number of inbound tourists to the country has dropped 25 percent since December, while the influx of female travelers is down 35 percent.

That's not surprising, since research shows that violence and other upheaval tends to scare away tourists.

So, which countries should foreign travelers avoid, or at least be especially careful in?

Statistics for attacks on tourists are hard to come by, but one way to look at travel risks is through the travel warnings that governments issue for their citizens. Here's a map put together by the CBC, based on warnings from Canada's Department of Foreign Affairs ( click here for the interactive version):

Brazil is flagged with an "exercise extreme caution" warning, while visitors to India are advised to avoid areas that tend to have conflicts flaring:

Avoid non-essential travel to the regions of Manipur and the Arunachal Pradesh border area with Burma. Avoid all travel to Jammu and Kashmir, with the exception of Ladakh via Manali or by air to Leh. Avoid all travel in border areas in Manipur (border with Burma) and Nagaland (border with Burma). Avoid all travel to the immediate vicinity of the border areas with Pakistan in Gujarat, Rajasthan and Punjab states. Avoid the border area between Assam and Bangladesh due to insurgency, and districts of Kokrajhar, Chirang and Dhubri due to inter-communal violence.

A danger of rape isn't mentioned -- perhaps because sexual assault, though sadly common for local women (as highlighted by an  earlier gang-rape of an Indian woman on a Delhi bus), is actually a rarity for tourists in India.

The U.S. State Department also puts out travel warnings when there's a long-term, protracted condition that makes a country too dangerous for Americans to visit.

Here is a map of all of the travel warnings that are in effect since September of last year. It likely doesn't come as a shock to anyone who reads foreign news, consisting largely of hotspots in North Africa, the Middle East, and a few outlying Asian countries such as North Korea:

Surprisingly, the U.S. list includes popular tourist destinations like Israel, where the U.S. government warns visitors to avoid the Gaza Strip and West Bank, and Mexico, where the State Department notes that, "the number of U.S. citizens...murdered under all circumstances in Mexico was 113 in 2011 and 32 in the first six months of 2012."

It's not entirely clear why Brazil isn't on the list. The country has one of the highest homicide rates per capita in the world , according to UNODC statistics. The State Department has published plenty of other warnings about vacationing there, including scary descriptions of " quicknappings " around banks and ATMs.

It could be just that crimes against tourists in Brazil tend to be muggings and theft, as opposed to violent assaults such as rape, so the country gets swept into the broad category of "have fun, but watch your bag" destinations. But in light of recent events, it will be interesting to see if there's a report showing a drop in Brazilian tourism a few months from now. But on thing both the Canadian and U.S. maps show is that sometimes, terrible things happen to innocent tourists -- no matter where they are.

Burden of Disease

How is the burden of disease distributed and how did it change over time?

By: Max Roser , Hannah Ritchie and Fiona Spooner

This page was first published in 2016, and last revised in February 2024.

To assess the health of a population, it’s straightforward to focus on mortality, or concepts like life expectancy , which are based on mortality estimates. But this does not take into account the suffering that diseases cause the people who live with them.

By looking at both mortality and morbidity (the prevalent diseases), we can have a more comprehensive understanding of health outcomes.

The sum of mortality and morbidity is called the “burden of disease” by researchers, and can be measured by a metric called “ Disability Adjusted Life Years ” (DALYs).

DALYs are standardized units to measure lost health. They help compare the burden of different diseases in different countries, populations, and times.

Conceptually, one DALY represents one lost year of healthy life – it is the equivalent of losing one year in good health because of either premature death or disease or disability.

DALYs have been measured in the Global Burden of Disease (GBD) study by the Institute of Health Metrics and Evaluation (IHME) since 1990, and by the “Disease Burden Unit” which was created in 1998 at the World Health Organization (WHO). It was also prominently featured in the World Bank’s 1993 World Development Report .

This topic page presents global data on the burden of disease across the world. The data is broken down by age, type of disability and disease, and country.

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Global Health

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See all interactive charts on the burden of disease ↓

The global distribution of the disease burden

This map shows the annual rate of DALYs per 100,000 people in the population. It is thereby measuring the distribution of the burden of both mortality and morbidity around the world.

In some regions with the best health, the rate of DALYs was under 20,000 per 100,000 people in 2019. In contrast, in the worst-off regions, the rate was several times higher than that – over 60,000 in several countries in Africa.

The disease burden by cause

Epidemiologists break the disease burden down into three categories of disability or disease: non-communicable diseases (NCDs); communicable, maternal , neonatal, and nutritional diseases; and injuries. These are shown in the chart below.

At a global level, the majority of the burden of disease results from non-communicable diseases (NCDs). Communicable, maternal, neonatal, and nutritional diseases are the next most common, and finally injuries.

The chart also shows a notable shift since 1990, when communicable diseases held the highest share of the disease burden.

It’s important to note that this chart shows the relative share of DALYs from each category.

This shift towards non-communicable diseases is because the global burden from communicable diseases has declined significantly over time.

In high-income nations, non-communicable diseases account for a large share of the overall burden of disease. In contrast, communicable diseases tend to make a small share. This is shown below.

The opposite is true in low-income nations, where communicable diseases are still common.

How do different diseases and disabilities contribute towards the burden of disease?

The two charts here show the breakdown of disease burden by cause. One chart shows the number of DALYs by cause, while the other shows the share of DALYs by cause.

At a global level, the largest disease burden in 2019 comes from cardiovascular diseases. This is followed by cancers , neonatal disorders, musculoskeletal disorders, respiratory infections, and mental and substance use disorders.

The ranking of these causes varies significantly across the world. You can explore the data by using the “Edit countries and regions” button in the charts.

In low-income countries, communicable and neonatal diseases tend to rank much higher. This starkly contrasts with high-income countries, where communicable diseases may not be in the top ten, and instead, cardiovascular disease and cancers tend to contribute the largest burden.

The disease burden by age

In the two charts here we see the breakdown of total disease burden by age group. This is shown as the relative breakdown of the total disease burden and by the rates of burden per 100,000 individuals within the age group.

As you can see, rates of disease burden remain highest among the youngest and oldest in society. They have, however, seen the most notable declines in recent decades.

Overall we see a continued decline in burden of disease in children under five years old . This is also reflected in the relative share of burden of disease in children under five years old.

At a global level, collective rates across all ages have steadily declined. This shows that global health has improved considerably since then.

The disease burden from non-communicable diseases

The visualizations here focus on the disease burden resulting from non-communicable diseases (NCDs) .

The burden from non-communicable diseases by sub-category

The burden from non-communicable diseases by age, the burden from communicable, neonatal, maternal and nutritional diseases, the burden from communicable, neonatal, maternal, and nutritional diseases.

The charts here show that the burden of disease from communicable, neonatal, maternal, and nutritional diseases varies widely worldwide. There is a high burden in Sub-Saharan Africa and South Asia in particular.

Communicable, neonatal, maternal and nutritional disease burden by specific cause

There has been a significant reduction in global burden from communicable, neonatal, maternal, and nutritional diseases in recent decades.

Communicable, neonatal, maternal and nutritional disease burden by age

The majority of burden of disease from communicable, neonatal, maternal and nutritional disease is seen in children, but this share has declined over time.

The burden from injuries, violence, self-harm and accidents

“Injuries” is a broad category that encompasses accidents (unintentional injuries such as falls, fire, and drowning, as well as transport injuries), as well as natural disasters , and violence including interpersonal violence , conflict , terrorism , and self-harm .

The charts here provide an overview of the burden of disease from injuries.

The burden of injury, violence, self-harm, and accidents by type

The chart shows the burden of disease from injuries, broken down by type. Road accidents, interpersonal violence, and self-harm contribute large shares to the burden of disease.

You will also notice that the burden attributed to both conflict & terrorism and natural disasters are highly volatile, creating dramatic spikes in some years.

The burden from injuries, violence, self-harm, and accidents by age

Income and disease burden.

The chart shows the relationship between average income — measured by GNI per capita — and the burden of disease, with global data from 2012.

The burden of disease is broken down into communicable diseases and non-communicable diseases .

The chart shows that communicable diseases in particular are closely correlated to average income levels. The relationship that was estimated by Sterck et al. 2017 1 is shown in the legend. GNI per capita has a strong negative correlation with log DALYs lost due to communicable diseases, with an elasticity of -0.88. In other words, higher incomes are strongly correlated with fewer DALYs lost to communicable diseases.

On the other hand, the non-communicable disease burden is much less strongly associated with average income (the elasticity is estimated to be -0.13). So, higher incomes are also correlated with fewer DALYs lost to communicable diseases, but the change is much less strong.

Another conclusion we can draw from this chart is that the relationship between GNI per capita and DALYs lost due to the disease burden of communicable diseases is best captured by a log-log function.

Income and disease burden from communicable diseases

The burden of disease due to communicable diseases vs GDP per capita is shown in the following charts.

The correlation between both measures is apparent: both DALY loss rates and the total share from communicable diseases tend to decline with increasing incomes. But despite this correlation, Sterck et al. 2017 1 find that GNI is not a significant predictor of health outcomes once other factors are controlled for.

The first of these other factors is individual poverty — relative to a health poverty line of 10.89 international-$ per day. The second factor is the epidemiological surrounding of a country which captures the health status of neighbouring countries. And the third important factor is institutional capacity.

Income and disease burden from non-communicable diseases

The two charts here highlight two important relationships between non-communicable disease (NCDs) burden and income. The first suggests that rates of disease burden from NCDs are highest at lower incomes and tend to decline with development.

However, NCDs also constitute a higher share of disease burden at higher incomes. This is because communicable diseases decline more greatly with income than non-communicable diseases do.

Disease burden and health expenditure

The chart below shows the relationship between the total burden of disease versus average health expenditure per person, measured in US dollars.

At low levels of health expenditure , there is a steep decline in the disease burden as expenditure rises. However, as incomes rise, the magnitude of the decline slows down.

Interactive charts on the burden of disease

Sterck, O., Roser, M., Ncube, M., Thewissen, S. (forthcoming) — Allocation of development assistance for health: Is the predominance of national income justified? (accepted in Health Policy and Planning).

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Coronavirus World Map: Tracking the Global Outbreak

The New York Times Updated March 10, 2023

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New reported deaths by day, cases by region.

This chart shows how cases per capita have changed in different parts of the world.

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Reported cases, deaths and vaccinations by country

This table is sorted by places with the most cases per 100,000 residents in the last seven days. Charts show change in daily averages and are each on their own scale.

About the data

Data for all countries except the United States comes from the Center for Systems Science and Engineering at Johns Hopkins University. United States data comes from state and local health officials and is collected by The New York Times . Population data from the World Bank and U.S. Census Bureau. Data for some countries, like the United States, Denmark, France and the Netherlands, include counts for overseas territories. The New York Times has found that official tallies in more than thirty countries have undercounted deaths during the coronavirus outbreak because of limited testing availability.

The Times has identified reporting anomalies or methodology changes in the data.

• Jan. 12, 2023: China reported more than a month's worth of hospitalized new cases and deaths.
• Nov. 11, 2022: For deaths in the United States, the Times began including death certificate data reconciled by the C.D.C., resulting in a one-day increase in total deaths.
• March 21, 2022: Chile added probable Covid-19 deaths from earlier in the pandemic.
• July 20, 2021: Ecuador added a backlog of deaths from 2020.
• Dec. 25, 2020: Several countries did not publish data on Dec. 25.
• Dec. 10, 2020: Turkey announced the total number of reported cases, including asymptomatic cases since the end of July, reaching more than 1.7 million cases.

Confirmed cases and deaths , which are widely considered to be an undercount of the true toll, are counts of individuals whose coronavirus infections were confirmed by a molecular laboratory test. Probable cases and deaths count individuals who meet criteria for other types of testing, symptoms and exposure, as developed by national and local governments.

Governments often revise data or report a single-day large increase in cases or deaths from unspecified days without historical revisions, which can cause an irregular pattern in the daily reported figures. The Times is excluding these anomalies from seven-day averages when possible. For agencies that do not report data every day, variation in the schedule on which cases or deaths are reported, such as around holidays, can also cause an irregular pattern in averages. The Times uses an adjustment method to vary the number of days included in an average to remove these irregularities.

Tracking the Coronavirus

By Jordan Allen, Sarah Almukhtar , Aliza Aufrichtig , Anne Barnard, Matthew Bloch , Penn Bullock, Sarah Cahalan, Weiyi Cai, Julia Calderone, Keith Collins , Matthew Conlen, Lindsey Cook, Gabriel Gianordoli , Amy Harmon , Rich Harris , Adeel Hassan , Jon Huang , Danya Issawi, Danielle Ivory , K.K. Rebecca Lai , Alex Lemonides, Eleanor Lutz , Allison McCann , Richard A. Oppel Jr. , Jugal K. Patel , Alison Saldanha, Kirk Semple, Shelly Seroussi, Julie Walton Shaver, Amy Schoenfeld Walker , Anjali Singhvi , Charlie Smart , Mitch Smith , Albert Sun , Rumsey Taylor , Lisa Waananen Jones, Derek Watkins , Timothy Williams , Jin Wu and Karen Yourish .   ·   Reporting was contributed by Jeff Arnold, Ian Austen , Mike Baker , Brillian Bao, Ellen Barry , Shashank Bengali , Samone Blair, Nicholas Bogel-Burroughs, Aurelien Breeden, Elisha Brown, Emma Bubola, Maddie Burakoff, Alyssa Burr, Christopher Calabrese, Julia Carmel, Zak Cassel, Robert Chiarito, Izzy Colón, Matt Craig, Yves De Jesus, Brendon Derr, Brandon Dupré, Melissa Eddy, John Eligon, Timmy Facciola, Bianca Fortis, Jake Frankenfield, Matt Furber, Robert Gebeloff, Thomas Gibbons-Neff, Matthew Goldstein , Grace Gorenflo, Rebecca Griesbach, Benjamin Guggenheim, Barbara Harvey, Lauryn Higgins, Josh Holder, Jake Holland, Anna Joyce, John Keefe , Ann Hinga Klein, Jacob LaGesse, Alex Lim, Alex Matthews, Patricia Mazzei, Jesse McKinley, Miles McKinley, K.B. Mensah, Sarah Mervosh, Jacob Meschke, Lauren Messman, Andrea Michelson, Jaylynn Moffat-Mowatt, Steven Moity, Paul Moon, Derek M. Norman, Anahad O’Connor, Ashlyn O’Hara, Azi Paybarah, Elian Peltier, Richard Pérez-Peña , Sean Plambeck, Laney Pope, Elisabetta Povoledo, Cierra S. Queen, Savannah Redl, Scott Reinhard , Chloe Reynolds, Thomas Rivas, Frances Robles, Natasha Rodriguez, Jess Ruderman, Kai Schultz , Alex Schwartz, Emily Schwing, Libby Seline, Rachel Sherman, Sarena Snider, Brandon Thorp, Alex Traub, Maura Turcotte, Tracey Tully, Jeremy White , Kristine White, Bonnie G. Wong, Tiffany Wong, Sameer Yasir and John Yoon.   ·   Data acquisition and additional work contributed by Will Houp, Andrew Chavez, Michael Strickland, Tiff Fehr, Miles Watkins, Josh Williams , Nina Pavlich, Carmen Cincotti, Ben Smithgall, Andrew Fischer, Rachel Shorey , Blacki Migliozzi , Alastair Coote, Jaymin Patel, John-Michael Murphy, Isaac White, Steven Speicher, Hugh Mandeville, Robin Berjon, Thu Trinh, Carolyn Price, James G. Robinson, Phil Wells, Yanxing Yang, Michael Beswetherick, Michael Robles, Nikhil Baradwaj, Ariana Giorgi, Bella Virgilio, Dylan Momplaisir, Avery Dews, Bea Malsky, Ilana Marcus, Sean Cataguni and Jason Kao .

11 U.S. Tourists Have Died in the Dominican Republic in 2019. Should You Cancel Your Trip?

T he State Department confirmed to TIME that 46-year-old Denver resident, Khalid Adkins, died in the Dominican Republic on June 25, raising the number of U.S. tourist deaths in the Caribbean country in 2019 to 11.

Amid the headlines about tourist deaths, Delta Airlines announced it would allow passengers with tickets to Punta Cana, where at least three U.S. tourists have died––to cancel or reschedule their flights “due to recent events.”

Delta passengers who purchased tickets to Punta Cana airport before June 21 have until Aug. 15 to reschedule their flights to any date on or before Nov. 20, without being charged a change fee.

Passengers who choose to cancel their flights entirely have a year from the booking date to use the credits.

Last week, Hard Rock Hotel & Casino announced it would be removing liquor dispensers from all guest rooms at the Punta Cana location, along with other safety measures. In a statement, the hotel clarified that it was doing this based on “guest feedback” and to “enhance safety moving forward,” not due to reports that some U.S. tourist deaths may have been caused by tainted alcohol. Neither U.S. nor Dominican officials have confirmed reports that authorities were investigating tainted alcohol.

According to Hard Rock, in addition to removing the liquor dispensers, all alcohol on the property will be brand-name and sourced from the U.S. except speciality drinks from the Dominican Republic, including Presidente beer.

Additionally, Hard Rock’s Punta Cana location will hire a U.S.-based healthcare facility and will contract a U.S.-based 3rd party testing lab to inspect and test all food and beverages.

The headlines about American tourists dying and have fueled speculation among travelers that the Caribbean country is an unsafe destination for travelers.

Safety concerns began to arise in May, when three seemingly healthy American tourists suddenly died in the same resort within the same week. The FBI has confirmed that it is assisting Dominican police with the investigations. The State Department said there has been no evidence of foul play and no sign that the deaths are connected.

Despite the tragic headlines, safety experts are cautioning travelers not to rush to conclusions. The connections, they say, are not immediately apparent and safety experts in particular say that the country is no more dangerous than it was before. “It’s not an overly dangerous place,” Matthew Bradley, a former CIA agent and current Regional Security Director of International SOS, a travel security company, tells TIME. “I would still consider the Dominican Republic a safe place to go.”

According to the State Department, last year 13 U.S. citizens died while traveling to the Dominican Republic. The number was 17 in 2017. More than 2.7 million U.S. tourists visited the island in 2017, making the island the fourth most popular travel destination for Americans.

In a statement, a State Department spokesperson tells TIME that there has not been an increase in the reported deaths of American tourist in the Dominican Republic.

“We have not seen an uptick in the number of U.S. citizen deaths reported to the Department,” the statement said.

But for those millions of travelers with trips booked, police and resort officials are asking the public to wait for conclusions from investigations before making assumptions — and denying there is anything nefarious at play.

11 American tourists have died in the Dominican Republic this year

This year there have been multiple high-profile cases involving American tourists dying while staying in the Dominican Republic. Seven deaths have been attributed to tourists becoming ill and dying of health related issues.

Khalid Adkins

According to the GoFundMe page started by his sister-in-law, Marla Strick, Adkins traveled to the Dominican Republic with his daughter last week when he suddenly became sick. During his flight back to Colorado on Sunday, Adkins became ill on the plane, vomiting, and was forced to go to a hospital in Santo Domingo.

Strick confirmed Adkins died on Tuesday and his family is raising funds to cover cost for him to return home. As of Thursday, the fundraiser has raised $21,903 out of it’s $20,000 goal.

“We need to get his body home anything helps please!!,” Strick posted. “We really want to know what happened! We just want to get his body home to hopefully get some answers.”

Jerry Curan

Curran, 78, died on Jan . 26 just days after traveling to the DR with his wife, according to NBC affiliate WKYC .

The family is suspicious about the death after Curran threw up and was unresponsive shortly after he and his wife had dinner the night they arrived, WKYC reports.

He was staying at the Hard Rock Hotel & Casino in Punta Cana.

“We want to find out what happened and why did he die,” Kellie Brown told WKYC.

Jerry Curran’s death certificate says he died Saturday January 26, but his family isn’t sure. https://t.co/qSYajovW0m — First Coast News (@FCN2go) June 14, 2019

Orlando Moore and Portia Ravenelle

In April, the bodies of New York City couple Orlando Moore, 40, and Portia Ravenelle, 52, were found after being reported missing for weeks. Dominican authorities confirmed that the couple died in a car accident in Santo Domingo.

Orlando Moore and his girlfriend, Portia Ravenelle, were supposed to return from the Dominican Republic on March 27. Police confirmed the couple checked out of their hotel, but family members say neither made it on the flight back home. https://t.co/S4UTw47xsw — NBC Nightly News with Lester Holt (@NBCNightlyNews) April 9, 2019

Robert Wallace

Relatives of Wallace, 67, told Fox News that he had died after visiting the Hard Rock Hotel & Casino Resort in Punta Cana. His niece Chloe Arnold told Fox that on April 11, Wallace fell ill after having a Scotch from his hotel room’s mini bar. After being checked by a hotel doctor on April 13, Wallace was sent to the hospital where he died on April 14.

Arnold described her uncle as an avid traveler in good health. His obituary says he passed “unexpectedly while vacationing in the Dominican Republic.”

Arnold told Fox that Dominican authorities have not yet confirmed her uncle’s cause of death.

“We have so many questions,” she said. “We don’t want this to happen to anyone else.”

Robert Wallace died three days after falling ill at the Hard Rock Hotel & Casino in April. https://t.co/zA1s0azGZw — Gage Goulding - KPRC 2 (@GageGoulding) June 11, 2019

Miranda Schaup-Werner

Schaup-Werner, 41, was found unresponsive by hotel staff in her Luxury Bahia Principe Bouganville resort hotel room on May 25. According to the hotel, which is located in San Pedro de Macoris, Dominican authorities concluded she had suffered a heart attack. In a statement, Bahia Principe said her husband, who Schaup-Werner was traveling with, confirmed she had a history of heart conditions.

Miranda Schaup-Werner, the first of three American tourists to die mysteriously within a week at a Dominican Republic resort, succumbed to a heart attack, the Caribbean island's attorney general said.​ https://t.co/zQa1Knttnl — WTVR CBS 6 Richmond (@CBS6) June 11, 2019

Cynthia Day and Nathaniel Holmes

Five days after the death of Schaup-Werner, Day, 49, and Holmes, 63, a couple from Maryland were found in their hotel rooms, unresponsive. They were staying at the Grand Bahia Principe La Romana, which is less than a mile away from sister resort Luxury Bahia Principe Bouganville where Schaup-Werner was staying. The case is still under investigation and there were no signs of violence in the case, according to the resort.

In response to the information that has been circulating in different media outlets regarding the two unfortunate events in the Dominican Republic, Bahia Principe Hotels & Resorts would like to clarify the following: pic.twitter.com/Pg8QFmaq1L — BahiaPrincipeHotels (@BahiaPrincipe) June 5, 2019

Leyla Cox, 53, was found dead in her hotel room on June 11 while staying at the Excellence Resort in Punta Cana.

“I am overwhelmed and confused and in shock,” William Cox, 25, Leyla’s son told the Staten Island Advance . “Her birthday was June 9 and she passed away on June 10.”

Leyla Cox, 53, died Tuesday, and another family has reported that their loved one died in the Dominican Republic in January. https://t.co/x7jxoGRtMp — NBC Nightly News with Lester Holt (@NBCNightlyNews) June 14, 2019

Joseph Allen

Allen, a New Jersey native, died while vacationing in the Dominican Republic, a State Department spokesperson confirms to TIME. Allen was found dead in his hotel room at Terra Linda Sosua on June 13, according to WABC in New York .

Jamie Reed, his sister, told WABC that her brother was celebrating a friend’s birthday and regularly visited the area.

“We didn’t think anything of it, because he does this all the time,” she told WABC.

It was really heartbreaking speaking to the family of Joseph Allen just a day after he was found dead. The 8th confirmed American tourist death in the Dominican Republic in the last year. Here's what Joseph's sister Jamie had to say: https://t.co/X5irvKaFzB — Stephanie Wash (@WashNews) June 17, 2019

Vittorio Caruso

Caruso, 56, died on June 17 after staying at the Boca Chica Resort in Santo Domingo.

His family told Fox News that he had been traveling by himself and he was in good health.

His sister-in-law, Lisa Maria Caruso, said Caruso was taken to a hospital in respiratory distress after “drinking something.”

The family is still awaiting autopsy reports but said they have been told “conflicting stories from different people” about the circumstances surrounding Caruso’s death.

Dominican Republic Tourist Deaths: Long Island Community Shocked Over Loss Of Former Pizzeria Owner https://t.co/QG4Zh1B7RB — CBS New York (@CBSNewYork) June 24, 2019

Other high-profile incidents

David Ortiz , the former Red Sox slugger, was ambushed on June 9 while sitting outside a lounge bar in Santo Domingo, the Dominican Republic’s capital and largest city. Surveillance footage of the attack shows a motorist approaching Ortiz and opening fire, striking the retired baseball star and others in his group.

Dominican authorities on June 17 identified the man they believe paid hit men to try and kill Ortiz, adding that they were closing in on the mastermind and motive behind the shooting, the Associated Press reported. Authorities have 10 people in custody related to the shooting and are looking for at least two others.

Dozens of members of the Central Oklahoma Parrothead Association , a group for fans of Jimmy Buffet and trop rock, say they fell “seriously ill” days into their stay at the Hotel Riu Palace Macao in Punta Cana in April.

Dana Flowers, a member and the travel agent, tells TIME that 47 of the 114 members traveling with the group got sick almost immediately, including him.

“It was as bad as it gets,” he says.”Three days in we started noticing people did not make it to concerts and events, it was then we realized they were all sick. It all happened pretty quickly and in pretty good numbers, it was obvious that something is not right. We all thought it was food poisoning and so we went with that, you know this kind of thing happens occasionally, but then the numbers grew and we knew it was a serious issue.”

Flowers says a few members of the group visited the resort’s doctor who gave patients medication for parasites.

RIU Hotels & Resorts, where the group, stayed tells TIME that doctors at the hotel treated three patients for gastroenteritis and were not able to determine the source of their stomach flu.

How safe is the Dominican Republic?

State Department issued a level two (out of four) safety warning for the Dominican Republic in April 2019. The warning advises travelers exercise increased caution due to violent crime in the country, which include armed robbery, homicide and sexual assault. The State Department says that resort areas tend to be better policed and safer that urban areas for travelers.

Bradley, the International SOS analyst, says there is likely a reasonable explanation for the spate of tourist deaths.

“It’s the mystery around the deaths that is driving the speculation,” he tells TIME. “American tourists pass away frequently around the world, several in a day, it’s not unusual. But it is unusual hearing about Americans passing away abroad without it being something like a terrorist attack. We usually don’t hear about tourists dying of heart attacks or in their sleep, but that happens everyday with tourist traveling abroad, it is nothing unique to the Dominican Republic.”

He says prospective travelers who are concerned about the recent deaths, should make sure they have a plan for what to do if they get ill. Bradley suggests travelers should have the phone number for the best nearby hospitals and should check with their insurance providers to make sure they will be covered while traveling. He says travelers can ask hotels whether they offer on-site medical assistance. Travelers can also make arrangements to get immediate medical care back home if they have to leave unexpectedly.

“I don’t think people should distrust Dominican officials,” he adds. “They’re working with what they have. Like they said, 2 million Americans visit DR (Dominican Republic) every year and only a handful have died.”

Bradley says he would advise anyone worried about traveling to the Dominican Republic to take the same precautions they would when going anywhere else.

“These incidents, while recent, in my mind don’t indicate Dominican Republic is any less safe than it was before,” Bradley says. “I would tell people to continue with trips.”

Considering the level two safety ranking from the State Department, Bradley advises travelers not to go anywhere alone, especially at night. And if you do wander on your own, Bradley says , let a companion know when you plan on returning so they can be aware something is amiss if you do not return. “Travel has risk,” Bradley says. “People should be aware before they travel where they are going and plan accordingly, if they do, they usually travel safely.”

Dr. Robert Quigley, Senior Vice President and Regional Medical Director of International SOS says travelers should take extra precaution with their health when away from home.

He advises travelers to visit a doctor prior to embarking on their trip, especially if they might have a chronic medical condition or cardiovascular disease. Quigley says sleep deprivation and stress can “exacerbate underlying, and sometimes asymptomatic, serious cardiovascular diseases.”

He also advised travelers to pack extra medication in case their trip home is delayed.

Will tourism in the Dominican Republic be affected?

As the stories continue to emerge, some travelers have taken to social media to voice concerns about traveling to the Caribbean country. While officials at the Dominican Ministry of Tourism told TIME they were not able to elaborate on the situation because of the ongoing investigation, Francisco Javier García, the Minister of Tourism for Dominican Republic said that the investigations are not affecting the number of tourist visiting the country.

“These cases are very regrettable, but isolated.” he said at a press conference in June. “Investigation into them is a top priority for us and for the National Police. We are asking them to deploy all resources to help provide answers as quickly as possible.”

He called the Dominican Republic a “tranquil, peaceful destination and the safest in the region,” and said tourists can “be assured that the authorities are working hard to clarify these incidents.”

Despite the reassurance, some travelers are saying the incidents have cast doubt on the safety of the country and are refusing to take a chance.

Until the Dominican Republic can pinpoint what is happening to tourist in their country, please stay out of the DR. If you have a hotel, cancel it. We cannot support a country that is not handling this with the utmost confidence that they will find the person/persons. RT — Macrö (@hayxteci) June 18, 2019

Been contemplating canceling my vacation to the Dominican Republic, but David Ortiz getting shot is the last straw. — Hank Mardukas (@HankMardukas93) June 10, 2019

Correction June 27

The original version of this story misstated the Dominican Republic’s largest city. It is Santo Domingo, not Punta Cana

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Home > Student Scholarship > Master of Education in Applied Human Development Graduate Projects > 44

Master of Education in Applied Human Development Graduate Projects

The global epidemiology of tourist fatalities.

Caley Reid , Bowling Green State University

With the yearly increase of travelers around the world, tourist fatalities continue to rise. As seen before with infectious diseases, the proper evaluation of the diseases causing tourist mortality and the creation of effective preventive plans has helped to decrease tourist mortality from these ailments. The objective of this study is to identify the types of pre-death activities leading to trauma-based tourist fatalities, contributing factors in fatal incidents, and the demographic trends of the tourist fatalities. The findings reinforce industry trends from previous studies, implying that the creation of a tourist fatality database would have large levels of effectiveness in the creation of preventive and educational plans to significantly decrease the number of trauma-based tourist fatalities. Between January 1, 2013 and December 31, 2015, there were 3,121 tourist fatalities reports. As seen with many other studies, transportation-based fatalities were among the highest recorded with 875 (28%) incidents. However, this study concluded that water-based activities, specifically swimming and boating, are now the largest cause of mortality with 1,035 (33.2%) reported. Nearly half (49.4%) of the fatalities recorded took place in Asian countries, followed by European (15.3%) and African (14.6%) countries. The study also found that Asian tourists accounted for the highest number of fatalities (37.1%), followed by European (17.9%) and American (7.9%) tourists. Press releases report on a biased standard, focusing on tourist fatalities that have shock value, rather than reporting on tourists dying of natural causes or illnesses. As seen in previous tourist fatality studies, the data collected lacks an accurate denominator to calculate the actual rate of fatalities. This does not take away from the significance of this study’s findings, as this information is valuable to medical practitioners, travel medicine, and the travel industry as a whole for aiding in the reduction of tourist mortality worldwide.

Travis Heggie

Second Reader

Bingjie Liu

Repository Citation

Reid, Caley, "The Global Epidemiology of Tourist Fatalities" (2017). Master of Education in Applied Human Development Graduate Projects . 44. https://scholarworks.bgsu.edu/hmsls_mastersprojects/44

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This North American country tops the list of the safest countries for travelers

A new year means new destinations.

When looking at where to go, travelers will consider the usual factors such as weather, cost and available activities. This year, safety is also top of mind as more people want to go off the beaten path and take solo trips.

To help, travel insurance provider Berkshire Hathaway Travel Protection just released its ninth annual State of Travel Insurance report, which includes the safest countries in the world for travelers.

"The definition of safe destination has evolved,” Carol Mueller, vice president at Berkshire Hathaway Travel Protection, told USA TODAY in an email. "In our most recent survey, travelers lean in on countries they believe as safe destinations they can move about freely without discrimination or harassment."

To determine the list, the travel insurance provider surveyed 1,702 people on their own travel experiences in different countries and also pulled data from third-party resources that evaluate safety concerns such as terrorism, weather emergencies, health measures and the safety of underrepresented groups. This included the  Global Peace Index  and the State Department’s own  travel safety ratings .

Learn more: Best travel insurance

While these countries are considered to be overall safe for people to visit, the company noted the report doesn't mean every part of the country is safe nor account for the possibility of natural disasters. And as always, don't let your guard down when it comes to petty theft against tourists.

'It's like your local bestie': This startup helps make solo travel as a woman feel safer

Read below to see the 15 countries determined to be the safest for all travelers.

The Great White North tops this year's list of safest countries in the world for travelers, thanks to its low violent crime and strict gun laws. Last year, the country, known for its high standard of living and political stability, made sixth on the list.

2. Switzerland

Known for its security and low crime rates, Switzerland made second place for the safest nations to visit. The country is known for its high quality of living and beautiful nature, such as Lake Geneva and Lake Zurich.

Besides having some of the best views of the dancing northern lights , Norway is also one of the safest places when it comes to crime rates, terrorist activity and violent demonstrations. According to the report, Oslo, the capital of Norway, was the country's safest area.

Those wanting to see Ireland's Cliffs of Moher or sip on some Guinness can rest assured in going through with those travel plans. The country had fewer homicides in 2022 than 16 U.S. cities, according to the report.

5. Netherlands

Last year, the Netherlands took the top spot for safest destinations to visit, and this year, it made fifth. Survey respondents repeatedly said they felt safe in the country and its capital Amsterdam. Just beware of the tourist tax increase as the city continues to crack down on reckless partiers.

6. United Kingdom

With a beautiful countryside and cities with low murder and theft rates, the United Kingdom is a safe bet for travelers. Unfortunately, the country is soon going to implement a fee to enter its borders .

7. Portugal

There's a reason digital nomads flock to this sunny coastal country, and it's not just the delicious seafood and wine. Portugal's cities are secure and orderly, and the rural areas are peaceful. In 2022, the country was determined to be one of the best places for solo female travelers too.

Last year, Denmark was the second safest country in the world for travelers, and its low crime rates continue to help it be a safe choice for travelers. The northern European country typically steals the spotlight for its happy residents and its politics.

Like its Nordic neighbor Denmark, Iceland is often regarded as the world's most gender-equal country and the safest country in the world when it comes to crime. To entice travelers even more, the country is home to otherworldly landscapes featuring glaciers, geysers, hot springs, waterfalls and volcanic terrain.

10. Australia

Rugged wilderness and cosmopolitan cities make Australia a desirable country for travelers, especially female solo travelers since the Land Down Under also has low homicide rates. In 2022, there were 377 recorded homicides, about half of what Chicago experienced, according to the report.

11. New Zealand

Although expensive, New Zealand is a paradise for outdoor enthusiasts who want to explore its coastlines, mountains, fjords and more, or for those who are big "Lord of the Rings" fans. With low crime rates, the country is also considered to be quite peaceful and great for female solo travelers.

Along with low crime rates, Japan offers travelers a blend of ancient traditions and cutting-edge modernity. Think robot servers in restaurants amongst ancient shrines. In Japanese culture, politeness and orderliness are also highly valued, making it a safe place for travelers, solo or not. However, the report doesn't consider natural disasters, such as the earthquakes that recently shook the western part of the island nation.

Home to the City of Light, France has stood the test of time as one of the world's most popular destinations. Thankfully, for travelers, the country has relatively safe transportation (well, minus petty theft, which is common on the metro) and safety from disease epidemics, according to the report. However, violent demonstrations mean travelers should be cautious and check local media for updates.

Another popular European destination, Spain is known for petty theft like pickpocketing. Overall, the Mediterranean country has a low crime rating for how heavily touristed it is, the report said. Berkshire Hathaway Travel Protection recommends people especially watch out for passport thefts, so as always, travel cautiously.

This year, Brazil made the list of safe countries to visit. The survey respondents who identified as women, people of color and LGBTQ+ especially felt safe in the South American country, known for its beautiful beaches. However, Brazil's borders are notably dangerous for crime activity.

Kathleen Wong is a travel reporter for USA TODAY based in Hawaii. You can reach her at [email protected] .

Excess mortality across countries in the Western World since the COVID-19 pandemic: ‘Our World in Data’ estimates of January 2020 to December 2022

Marcel Hoogland ,

Minke Huibers ,

Gertjan Kaspers .

https://doi.org/ 10.1136/bmjph-2023-000282

Introduction Excess mortality during the COVID-19 pandemic has been substantial. Insight into excess death rates in years following WHO’s pandemic declaration is crucial for government leaders and policymakers to evaluate their health crisis policies. This study explores excess mortality in the Western World from 2020 until 2022.

Methods All-cause mortality reports were abstracted for countries using the ‘Our World in Data’ database. Excess mortality is assessed as a deviation between the reported number of deaths in a country during a certain week or month in 2020 until 2022 and the expected number of deaths in a country for that period under normal conditions. For the baseline of expected deaths, Karlinsky and Kobak’s estimate model was used. This model uses historical death data in a country from 2015 until 2019 and accounts for seasonal variation and year-to-year trends in mortality.

Results The total number of excess deaths in 47 countries of the Western World was 3 098 456 from 1 January 2020 until 31 December 2022. Excess mortality was documented in 41 countries (87%) in 2020, 42 countries (89%) in 2021 and 43 countries (91%) in 2022. In 2020, the year of the COVID-19 pandemic onset and implementation of containment measures, records present 1 033 122 excess deaths (P-score 11.4%). In 2021, the year in which both containment measures and COVID-19 vaccines were used to address virus spread and infection, the highest number of excess deaths was reported: 1 256 942 excess deaths (P-score 13.8%). In 2022, when most containment measures were lifted and COVID-19 vaccines were continued, preliminary data present 808 392 excess deaths (P-score 8.8%).

Conclusions Excess mortality has remained high in the Western World for three consecutive years, despite the implementation of containment measures and COVID-19 vaccines. This raises serious concerns. Government leaders and policymakers need to thoroughly investigate underlying causes of persistent excess mortality.

What is already known on this topic

Excess mortality during the COVID-19 pandemic has been substantial. Insight into excess death rates in years following WHO’s pandemic declaration is crucial for government leaders and policymakers to evaluate their health crisis policies.

What this study adds

Excess mortality has remained high in the Western World for three consecutive years, despite the implementation of containment measures and COVID-19 vaccines. This raises serious concerns.

How this study might affect research, practice or policy

Government leaders and policymakers need to thoroughly investigate the underlying causes of persistent excess mortality.

• Introduction

Excess mortality is internationally recognised as an accurate measure for monitoring and comparing health crisis policies across geographic regions. 1–4 Excess mortality concerns the number of deaths from all causes during a humanitarian emergency, such as the COVID-19 pandemic, above the expected number of deaths under normal circumstances. 5–7 Since the outbreak of the COVID-19 pandemic, excess mortality thus includes not only deaths from SARS-CoV-2 infection but also deaths related to the indirect effects of the health strategies to address the virus spread and infection. 1–4 The burden of the COVID-19 pandemic on disease and death has been investigated from its beginning. Numerous studies expressed that SARS-CoV-2 infection was likely a leading cause of death among older patients with pre-existing comorbidities and obesity in the early phase of the pandemic, that various containment measures were effective in reducing viral transmission and that COVID-19 vaccines prevented severe disease, especially among the elderly population. 1 8–14 Although COVID-19 containment measures and COVID-19 vaccines were thus implemented to protect citizens from suffering morbidity and mortality by the COVID-19 virus, they may have detrimental effects that cause inferior outcomes as well. 1 2 15 It is noteworthy that excess mortality during a crisis points to a more extensive underlying burden of disease, disablement and human suffering. 16

On 11 March 2020, WHO declared the COVID-19 pandemic. 17 Countries in the Western World promptly implemented COVID-19 containment measures (such as lockdowns, school closures, physical distancing, travel restrictions, business closures, stay-at-home orders, curfews and quarantine measures with contact tracing) to limit virus spread and shield its residents from morbidity and mortality. 18 These non-pharmaceutical interventions however had adverse indirect effects (such as economic damage, limited access to education, food insecurity, child abuse, limited access to healthcare, disrupted health programmes and mental health challenges) that increased morbidity and mortality from other causes. 19 Vulnerable populations in need of acute or complex medical treatment, such as patients with cardiovascular disease, cerebrovascular conditions, diabetes and cancer, were hurt by these interventions due to the limited access to and delivery of medical services. Shortage of staff, reduced screening, delayed diagnostics, disrupted imaging, limited availability of medicines, postponed surgery, modified radiotherapy and restricted supportive care hindered protocol adherence and worsened the condition and prognosis of patients. 19–26 A recent study investigated excess mortality from some major non-COVID causes across 30 countries in 2020. Significant excess deaths were reported from ischaemic heart diseases (in 10 countries), cerebrovascular diseases (in 10 countries) and diabetes (in 19 countries). 27 On 14 October 2020, Professor Ioannidis from Stanford University published an overall Infection Fatality Rate of COVID-19 of 0.23%, and for people aged <70 years, the Infection Fatality Rate was 0.05%. 28 Governments in the Western World continued to impose lockdowns until the end of 2021.

In December 2020, the UK, the USA and Canada were the first countries in the Western World that started with the roll-out of the COVID-19 vaccines under emergency authorisation. 29–31 At the end of December 2020, a large randomised and placebo-controlled trial with 43 548 participants was published in the New England Journal of Medicine , which showed that a two-dose mRNA COVID-19 vaccine regimen provided an absolute risk reduction of 0.88% and relative risk reduction of 95% against laboratory-confirmed COVID-19 in the vaccinated group (8 COVID-19 cases/17 411 vaccine recipients) versus the placebo group (162 COVID-19 cases/17 511 placebo recipients). 32 33 At the beginning of 2021, most other Western countries followed with rolling out massive vaccination campaigns. 34–36 On 9 April 2021, the overall COVID-19 Infection Fatality Rate was reduced to 0.15% and expected to further decline with the widespread use of vaccinations, prior infections and the evolution of new and milder variants. 37 38

Although COVID-19 vaccines were provided to guard civilians from suffering morbidity and mortality by the COVID-19 virus, suspected adverse events have been documented as well. 15 The secondary analysis of the placebo-controlled, phase III randomised clinical trials of mRNA COVID-19 vaccines showed that the Pfizer trial had a 36% higher risk of serious adverse events in the vaccine group. The risk difference was 18.0 per 10 000 vaccinated (95% CI 1.2 to 34.9), and the risk ratio was 1.36 (95% CI 1.02 to 1.83). The Moderna trial had a 6% higher risk of serious adverse events among vaccine recipients. The risk difference was 7.1 per 10 000 vaccinated (95% CI −23.2 to 37.4), and the risk ratio was 1.06 (95% CI 0.84 to 1.33). 39 By definition, these serious adverse events lead to either death, are life-threatening, require inpatient (prolongation of) hospitalisation, cause persistent/significant disability/incapacity, concern a congenital anomaly/birth defect or include a medically important event according to medical judgement. 39–41 The authors of the secondary analysis point out that most of these serious adverse events concern common clinical conditions, for example, ischaemic stroke, acute coronary syndrome and brain haemorrhage. This commonality hinders clinical suspicion and consequently its detection as adverse vaccine reactions. 39 Both medical professionals and citizens have reported serious injuries and deaths following vaccination to various official databases in the Western World, such as VAERS in the USA, EudraVigilance in the European Union and Yellow Card Scheme in the UK. 42–48 A study comparing adverse event reports to VAERS and EudraVigilance following mRNA COVID-19 vaccines versus influenza vaccines observed a higher risk of serious adverse reactions for COVID-19 vaccines. These reactions included cardiovascular diseases, coagulation, haemorrhages, gastrointestinal events and thromboses. 39 49 Numerous studies reported that COVID-19 vaccination may induce myocarditis, pericarditis and autoimmune diseases. 50–57 Postmortem examinations have also ascribed myocarditis, encephalitis, immune thrombotic thrombocytopenia, intracranial haemorrhage and diffuse thrombosis to COVID-19 vaccinations. 58–67 The Food and Drug Administration noted in July 2021 that the following potentially serious adverse events of Pfizer vaccines deserve further monitoring and investigation: pulmonary embolism, acute myocardial infarction, immune thrombocytopenia and disseminated intravascular coagulation. 39 68

Insight into the excess death rates in the years following the declaration of the pandemic by WHO is crucial for government leaders and policymakers to evaluate their health crisis policies. 1–4 This study therefore explores excess mortality in the Western World from 1 January 2020 until 31 December 2022.

• Materials and methods

The Western World is primarily defined by culture rather than geography. It refers to various countries in Europe and to countries in Australasia (Australia, New Zealand) and North America (the USA, Canada) that are based on European cultural heritage. The latter countries were once British colonies that acquired Christianity and the Latin alphabet and whose populations comprised numerous descendants from European colonists or migrants. 69

Study design

All-cause mortality reports were abstracted for countries of the Western World using the ‘Our World in Data’ database. 12 Only countries that had all-cause mortality reports available for all three consecutive years (2020–2022) were included. If coverage of one of these years was missing, the country was excluded from the analysis.

The ‘Our World in Data’ database retrieves their reported number of deaths from both the Human Mortality Database (HMD) and the World Mortality Dataset (WMD). 5 HMD is sustained by research teams of both the University of California in the USA and the Max Planck Institute for Demographic Research in Germany. HMD recovers its data from Eurostat and national statistical agencies on a weekly basis. 5 70 The ‘Our World in Data’ database used HMD as their only data source until February 2021. 5 WMD is sustained by the researchers Karlinsky and Kobak. WMD recovers its data from HMD, Eurostat and national statistical agencies on a weekly basis. 5 71 The ‘Our World in Data’ database started to use WMD as a data source next to HMD since February 2021. 5

‘Excess mortality’ is assessed as the deviation between the reported number of deaths in a country during a certain week or month in 2020 until 2022 and the expected or projected number of deaths in a country for that period under normal conditions. 5 For the baseline of expected deaths, the estimate model of Karlinsky and Kobak was used. This linear regression model uses historical death data in a country from 2015 until 2019 and accounts for seasonal variation in mortality and year-to-year trends due to changing population structure or socioeconomic factors. 5 7

‘Excess mortality P-score’ concerns the percentage difference between the reported number of deaths and the projected number of deaths in a country. 5 This measure permits comparisons between various countries. Although presenting the raw number of excess deaths provides insight into the scale, it is less useful to compare countries because of their large population size variations. 5 The ‘Our World in Data’ database presents P-scores in a country during a certain week or month in 2020 until 2022. 5 These P-scores are calculated from both the reported number of deaths in HMD and WMD and the projected number of deaths using the estimate model of Karlinsky and Kobak in WMD. 5 7 70 71

For correct interpretation of excess mortality provided by the ‘Our World in Data’ database, the following needs to be taken into consideration: the reported number of deaths may not represent all deaths, as countries may lack the infrastructure and capacity to document and account for all deaths. 5 In addition, death reports may be incomplete due to delays. It may take weeks, months or years before a death is actually reported. The date of a reported death may refer to the actual death date or to its registration date. Sometimes, a death may be recorded but not the date of death. Countries that provide weekly death reports may use different start and end dates of the week. Most countries define the week from Monday until Sunday, but not all countries do. Weekly and monthly reported deaths may not be completely comparable, as excess mortality derived from monthly calculations inclines to be lower. 5 7

For our analysis, weekly all-cause mortality reports from the ‘Our World in Data’ database were converted to monthly reports. Subsequently, the monthly reports were converted to annual reports.

Patient and public involvement

Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

The ‘Our World in Data’ database contained all-cause mortality reports of 47 countries (96%) in the Western World for the years 2020, 2021 and 2022. Only Andorra and Gibraltar were excluded. Both countries lacked all-cause mortality reports for the year 2022. Most countries (n=36, 77%) present weekly all-cause mortality reports, whereas 11 countries (23%) report monthly. The latter countries include the following: Albania, Bosnia Herzegovina, Faeroe Islands, Greenland, Kosovo, Liechtenstein, Moldova, Monaco, North Macedonia, San Marino and Serbia.

The all-cause mortality reports were abstracted from the ‘Our World in Data’ database on 20 May 2023. At this date, four countries (9%) still lacked all-cause mortality reports for various periods: Canada (1 month), Liechtenstein (3 months), Monaco (3 months) and Montenegro (4 months). It is noteworthy that all-cause mortality reports are also still being updated for the other countries due to registration delays which may take weeks, months or even years.

Excess mortality

Online supplemental table 1 illustrates that the total number of excess deaths in the 47 countries of the Western World was 3 098 456 from 1 January 2020 until 31 December 2022. Excess mortality was documented in 41 countries (87%) in 2020, in 42 countries (89%) in 2021 and in 43 countries (91%) in 2022.

In 2020, the year of the COVID-19 pandemic and implementation of the containment measures, 1 033 122 excess deaths (P-score 11.4%) were recorded. In 2021, the year in which both COVID-19 containment measures and COVID-19 vaccines were used to address virus spread and infection, a total of 1 256 942 excess deaths (P-score 13.8%) were reported. In 2022, the year in which most containment measures were lifted and COVID-19 vaccines were continued, preliminary available data counts 808 392 excess deaths (P-score 8.8%).

Figure 1 presents the excess mortality and cumulative excess mortality in 47 countries of the Western World over the years 2020, 2021 and 2022. The linear excess mortality trendline is almost horizontal.

Excess mortality and cumulative excess mortality in the Western World (n=47 countries). Preliminary and incomplete all-cause mortality reports are available for 2022.

Excess mortality P-scores

Figure 2 shows the excess mortality P-scores per country in the Western World. Only Greenland had no excess deaths between 2020 and 2022. Among the other 46 countries with reported excess mortality, the percentage difference between the reported and projected number of deaths was highest in 13 countries (28%) during 2020, in 21 countries (46%) during 2021 and in 12 countries (26%) during 2022. Figure 3 exemplifies excess mortality P-score curves of the highest-populated country of North America (the USA), the four highest-populated countries of Europe (Germany, France, the UK and Italy) and the highest-populated country of Australasia (Australia).

Excess mortality P-scores per country in the Western World (n=47 countries). Preliminary and incomplete all-cause mortality reports are available for 2022.

Excess mortality P-score curves of six countries in the Western World. Preliminary and incomplete all-cause mortality reports are available for 2022.

Figure 4 highlights a map of excess mortality P-scores in the Western World over the years 2020, 2021 and 2022. 74 Table 1 presents a classification of excess mortality P-scores in the Western World.

Map of excess mortality P-scores in the Western World (n=47 countries). 74 Preliminary and incomplete all-cause mortality reports are available for 2022.

This study explored the excess all-cause mortality in 47 countries of the Western World from 2020 until 2022. The overall number of excess deaths was 3 098 456. Excess mortality was registered in 87% of countries in 2020, in 89% of countries in 2021 and in 91% of countries in 2022. During 2020, which was marked by the COVID-19 pandemic and the onset of mitigation measures, 1 033 122 excess deaths (P-score 11.4%) were to be regretted. 17 18 A recent analysis of seroprevalence studies in this prevaccination era illustrates that the Infection Fatality Rate estimates in non-elderly populations were even lower than prior calculations suggested. 37 At a global level, the prevaccination Infection Fatality Rate was 0.03% for people aged <60 years and 0.07% for people aged <70 years. 38 For children aged 0–19 years, the Infection Fatality Rate was set at 0.0003%. 38 This implies that children are rarely harmed by the COVID-19 virus. 19 38 During 2021, when not only containment measures but also COVID-19 vaccines were used to tackle virus spread and infection, the highest number of excess deaths was recorded: 1 256 942 excess deaths (P-score 13.8%). 26 37 Scientific consensus regarding the effectiveness of non-pharmaceutical interventions in reducing viral transmission is currently lacking. 75 76 During 2022, when most mitigation measures were negated and COVID-19 vaccines were sustained, preliminary available data count 808 392 excess deaths (P-score 8.8%). 39 The percentage difference between the documented and projected number of deaths was highest in 28% of countries during 2020, in 46% of countries during 2021, and in 26% of countries during 2022.

This insight into the overall all-cause excess mortality since the start of the COVID-19 pandemic is an important first step for future health crisis policy decision-making. 1–4 The next step concerns distinguishing between the various potential contributors to excess mortality, including COVID-19 infection, indirect effects of containment measures and COVID-19 vaccination programmes. Differentiating between the various causes is challenging. 16 National mortality registries not only vary in quality and thoroughness but may also not accurately document the cause of death. 1 19 The usage of different models to investigate cause-specific excess mortality within certain countries or subregions during variable phases of the pandemic complicates elaborate cross-country comparative analysis. 1 2 16 Not all countries provide mortality reports categorised per age group. 2 12 Also testing policies for COVID-19 infection differ between countries. 1 2 Interpretation of a positive COVID-19 test can be intricate. 77 Consensus is lacking in the medical community regarding when a deceased infected with COVID-19 should be registered as a COVID-19 death. 1 77 Indirect effects of containment measures have likely altered the scale and nature of disease burden for numerous causes of death since the pandemic. However, deaths caused by restricted healthcare utilisation and socioeconomic turmoil are difficult to prove. 1 78–81 A study assessing excess mortality in the USA observed a substantial increase in excess mortality attributed to non-COVID causes during the first 2 years of the pandemic. The highest number of excess deaths was caused by heart disease, 6% above baseline during both years. Diabetes mortality was 17% over baseline during the first year and 13% above it during the second year. Alzheimer’s disease mortality was 19% higher in year 1 and 15% higher in year 2. In terms of percentage, large increases were recorded for alcohol-related fatalities (28% over baseline during the first year and 33% during the second year) and drug-related fatalities (33% above baseline in year 1 and 54% in year 2). 82 Previous research confirmed profound under-reporting of adverse events, including deaths, after immunisation. 83 84 Consensus is also lacking in the medical community regarding concerns that mRNA vaccines might cause more harm than initially forecasted. 85 French studies suggest that COVID-19 mRNA vaccines are gene therapy products requiring long-term stringent adverse events monitoring. 85 86 Although the desired immunisation through vaccination occurs in immune cells, some studies report a broad biodistribution and persistence of mRNA in many organs for weeks. 85 87–90 Batch-dependent heterogeneity in the toxicity of mRNA vaccines was found in Denmark. 48 Simultaneous onset of excess mortality and COVID-19 vaccination in Germany provides a safety signal warranting further investigation. 91 Despite these concerns, clinical trial data required to further investigate these associations are not shared with the public. 92 Autopsies to confirm actual death causes are seldom done. 58 60 90 93–95 Governments may be unable to release their death data with detailed stratification by cause, although this information could help indicate whether COVID-19 infection, indirect effects of containment measures, COVID-19 vaccines or other overlooked factors play an underpinning role. 1 8–14 20–25 39–60 68 90 This absence of detailed cause-of-death data for certain Western nations derives from the time-consuming procedure involved, which entails assembling death certificates, coding diagnoses and adjudicating the underlying origin of death. Consequently, some nations with restricted resources assigned to this procedure may encounter delays in rendering prompt and punctual cause-of-death data. This situation existed even prior to the outbreak of the pandemic. 1 5

A critical challenge in excess mortality research is choosing an appropriate statistical method for calculating the projected baseline of expected deaths to which the observed deaths are compared. 96 Although the analyses and estimates in general are similar, the method can vary, for instance, per length of the investigated period, nature of available data, scale of geographic area, inclusion or exclusion of past influenza outbreaks, accounting for changes in population ageing and size and modelling trend over years or not. 7 96 Our analysis of excess mortality using the linear regression model of Karlinsky and Kobak varies thus to some extent from previous attempts to estimate excess deaths. For example, Islam et al conducted an age- and sex-disaggregated time series analysis of weekly mortality data in 29 high-income countries during 2020. 97 They used a more elaborate statistical approach, an overdispersed Poisson regression model, for estimating the baseline of expected deaths on historical death data from 2016 to 2019. In contrast to the model of Karlinsky and Kobak, their baseline is weighing down prior influenza outbreaks so that every novel outbreak evolves in positive excess mortality. 7 97 Islam’s study found that age-standardised excess death rates were higher in men than in women in nearly all nations. 97 Alicandro et al investigated sex- and age-specific excess total mortality in Italy during 2020 and 2021, using an overdispersed Poisson regression model that accounts for temporal trends and seasonal variability. Historical death data from 2011 to 2019 were used for the projected baseline. When comparing 2020 and 2021, an increased share of the total excess mortality was attributed to the working-age population in 2021. Excess deaths were higher in men than in women during both periods. 98 Msemburi et al provided WHO estimates of the global excess mortality for its 194 member states during 2020 and 2021. For most countries, the historical period 2015–2019 was used to determine the expected baseline of excess deaths. In locations missing comprehensive data, the all-cause deaths were forecasted employing an overdispersed Poisson framework that uses Bayesian inference techniques to measure incertitude. This study describes huge differences in excess mortality between the six WHO regions. 99 Paglino et al used a Bayesian hierarchical model trained on historical death data from 2015 to 2019 and provided spatially and temporally granular estimates of monthly excess mortality across counties in the USA during the first 2 years of the pandemic. The authors found that excess mortality decreased in large metropolitan counties but increased in non-metropolitan counties. 100 Ruhm examined the appropriateness of reported excess death estimates in the USA by four previous studies and concluded that these investigations have likely understated the projected baseline of excess deaths and therewith overestimated excess mortality and its attribution to non-COVID causes. Ruhm explains that the overstatement of excess deaths may partially be explained by the fact that the studies did not adequately take population growth and age structure into account. 96 101–104 Although all the above-mentioned studies used more elaborate statistical approaches for estimating baseline mortality, Karlinsky and Kobak argue that their method is a trade-off between suppleness and chasteness. 7 It is the simplest method to captivate seasonal fluctuation and annual trends and more transparent than extensive approaches. 7

This study has various significant limitations. Death reports may be incomplete due to delays. It may take weeks, months or years before a death is registered. 5 Four nations still lack all-cause mortality reports for 1–4 months. Some nations issue complete data with profound arrears, whereas other nations publish prompt, yet incomplete data. 5 7 The presented data, especially for 2022, are thus preliminary and subject to backward revisions. The more recent data are usually more incomplete and therefore can undergo upward revisions over time. This implies that several of the reported excess mortality estimates can be underestimations. 7 The completeness and reliability of death registration data can also differ per nation for other reasons. The recorded number of deaths may not depict all deaths accurately, as the resources, infrastructure and registration capacity may be limited in some nations. 5 7 Most countries report per week, but some per month. Weekly reports generally provide the date of death, whereas monthly reports often provide the date of registration. Weekly and monthly reports may not be entirely comparable. 5 7 Our data are collected at a country level and provide no detailed stratification for sociodemographic characteristics, such as age or gender. 5 7

In conclusion, excess mortality has remained high in the Western World for three consecutive years, despite the implementation of COVID-19 containment measures and COVID-19 vaccines. This is unprecedented and raises serious concerns. During the pandemic, it was emphasised by politicians and the media on a daily basis that every COVID-19 death mattered and every life deserved protection through containment measures and COVID-19 vaccines. In the aftermath of the pandemic, the same morale should apply. Every death needs to be acknowledged and accounted for, irrespective of its origin. Transparency towards potential lethal drivers is warranted. Cause-specific mortality data therefore need to be made available to allow more detailed, direct and robust analyses to determine the underlying contributors. Postmortem examinations need to be facilitated to allot the exact reason for death. Government leaders and policymakers need to thoroughly investigate underlying causes of persistent excess mortality and evaluate their health crisis policies.

Dissemination to participants and related patient and public communities

We will disseminate findings through a press release on publication and contact government leaders and policymakers to raise awareness about the need to investigate the underlying causes of persistent excess mortality.

• Supplementary files
• Publication history

• Health, Pharma & Medtech ›

State of Health

• COVID-19 cases and deaths per million in 210 countries as of July 13, 2022

The difficulties of death figures

Where are these numbers coming from, coronavirus (covid-19) deaths worldwide per one million population as of july 13, 2022, by country.

Additional Information

Show sources information Show publisher information Use Ask Statista Research Service

Data as of July 13, 2022, 10:21 CET

Based on 2020 population figures; ¹ Figures without this country's dependencies. If daily change is negative, then the dependencies reported new figures earlier than the “main” country; This table shows worldwide countries with a population of one million or more. 55 countries or dependencies with a smaller population can be found under the "Details" tab.

• Montenegro, 244,337 cases (2,714 in last seven days), 2,730 deaths (1 in last seven days), roughly 4,394 per million (2 per million in last seven days);
• San Marino, 18,886 cases (525 in last seven days), 116 deaths (1 in last seven days), roughly 3,418 per million (29 per million in last seven days);
• Gibraltar, 19,796 cases (163 in last seven days), 105 deaths (1 in last seven days), roughly 3,117 per million (30 per million in last seven days);
• Martinique, 205,261 cases (4,050 in last seven days), 981 deaths (10 in last seven days), roughly 2,723 per million (28 per million in last seven days);
• Guadeloupe, 175,348 cases (3,917 in last seven days), 958 deaths (1 in last seven days), roughly 2,515 per million (3 per million in last seven days);
• Suriname, 80,919 cases (29 in last seven days), 1,377 deaths (1 in last seven days), roughly 2,347 per million (2 per million in last seven days);
• French Polynesia, 73,858 cases (472 in last seven days), 649 deaths (0 in last seven days), roughly 2,310 per million (0 per million in last seven days);
• Liechtenstein, 18,226 cases (194 in last seven days), 85 deaths (0 in last seven days), roughly 2,229 per million (0 per million in last seven days);
• Guam, 53,214 cases (851 in last seven days), 373 deaths (1 in last seven days), roughly 2,210 per million (6 per million in last seven days);
• Bermuda, 16,401 cases (239 in last seven days), 140 deaths (0 in last seven days), roughly 2,191 per million (0 per million in last seven days);
• Sint Maarten (Dutch part), 10,656 cases (55 in last seven days), 87 deaths (0 in last seven days), roughly 2,132 per million (0 per million in last seven days);
• Aruba, 41,448 cases (448 in last seven days), 224 deaths (2 in last seven days), roughly 2,098 per million (19 per million in last seven days);
• St. Lucia, 27,337 cases (204 in last seven days), 385 deaths (0 in last seven days), roughly 2,097 per million (0 per million in last seven days);
• The Bahamas, 36,299 cases (185 in last seven days), 822 deaths (2 in last seven days), roughly 2,090 per million (5 per million in last seven days);
• British Virgin Islands, 7,131 cases (190 in last seven days), 63 deaths (0 in last seven days), roughly 2,084 per million (0 per million in last seven days);
• Grenada, 18,560 cases (85 in last seven days), 233 deaths (1 in last seven days), roughly 2,071 per million (9 per million in last seven days);
• Andorra, 44,671 cases (494 in last seven days), 153 deaths (0 in last seven days), roughly 1,980 per million (0 per million in last seven days);
• Curaçao, 44,782 cases (237 in last seven days), 280 deaths (2 in last seven days), roughly 1,806 per million (13 per million in last seven days);
• Luxembourg, 272,520 cases (5,616 in last seven days), 1,100 deaths (6 in last seven days), roughly 1,740 per million (9 per million in last seven days);
• Belize, 65,508 cases (927 in last seven days), 680 deaths (0 in last seven days), roughly 1,710 per million (0 per million in last seven days);
• Seychelles, 45,076 cases (144 in last seven days), 167 deaths (0 in last seven days), roughly 1,696 per million (0 per million in last seven days);
• Barbados, 86,451 cases (1,330 in last seven days), 478 deaths (1 in last seven days), roughly 1,663 per million (3 per million in last seven days);
• St Martin (French part), 11,224 cases (163 in last seven days), 63 deaths (0 in last seven days), roughly 1,630 per million (0 per million in last seven days);
• Guyana, 68,409 cases (710 in last seven days), 1,263 deaths (7 in last seven days), roughly 1,606 per million (9 per million in last seven days);
• Monaco, 13,576 cases (379 in last seven days), 60 deaths (1 in last seven days), roughly 1,529 per million (25 per million in last seven days);
• Antigua and Barbuda, 8,686 cases (21 in last seven days), 143 deaths (2 in last seven days), roughly 1,460 per million (20 per million in last seven days);
• Malta, 109,493 cases (3,425 in last seven days), 763 deaths (12 in last seven days), roughly 1,453 per million (23 per million in last seven days);
• French Guiana, 89,779 cases (1,417 in last seven days), 402 deaths (1 in last seven days), roughly 1,405 per million (3 per million in last seven days);
• Isle of Man, 36,998 cases (535 in last seven days), 110 deaths (2 in last seven days), roughly 1,294 per million (24 per million in last seven days);
• New Caledonia, 66,596 cases (1,325 in last seven days), 314 deaths (1 in last seven days), roughly 1,155 per million (4 per million in last seven days);
• Virgin Islands (U.S.), 21,231 cases (236 in last seven days), 120 deaths (2 in last seven days), roughly 1,129 per million (19 per million in last seven days);
• Saint Vincent and the Grenadines, 9,127 cases (67 in last seven days), 114 deaths (0 in last seven days), roughly 1,028 per million (0 per million in last seven days);
• Fiji, 66,405 cases (516 in last seven days), 869 deaths (3 in last seven days), roughly 969 per million (3 per million in last seven days);
• Réunion, 425,638 cases (2,869 in last seven days), 819 deaths (7 in last seven days), roughly 949 per million (8 per million in last seven days);
• Dominica, 14,852 cases (0 in last seven days), 68 deaths (0 in last seven days), roughly 945 per million (0 per million in last seven days);
• Turks and Caicos Islands, 6,234 cases (0 in last seven days), 36 deaths (0 in last seven days), roughly 930 per million (0 per million in last seven days);
• Saint Kitts and Nevis, 6,332 cases (139 in last seven days), 45 deaths (2 in last seven days), roughly 846 per million (38 per million in last seven days);
• Cabo Verde, 61,669 cases (564 in last seven days), 409 deaths (4 in last seven days), roughly 736 per million (7 per million in last seven days);
• Mayotte, 38,139 cases (181 in last seven days), 187 deaths (0 in last seven days), roughly 669 per million (0 per million in last seven days);
• Northern Mariana Islands, 11,829 cases (0 in last seven days), 35 deaths (0 in last seven days), roughly 608 per million (0 per million in last seven days);
• Faroe Islands, 34,658 cases (0 in last seven days), 28 deaths (0 in last seven days), roughly 573 per million (0 per million in last seven days);
• Maldives, 183,491 cases (771 in last seven days), 307 deaths (1 in last seven days), roughly 568 per million (2 per million in last seven days);
• American Samoa, 6,505 cases (0 in last seven days), 31 death (0 in last seven days), roughly 562 per million (0 per million in last seven days);
• Brunei, 178,267 cases (9,507 in last seven days), 225 deaths (0 in last seven days), roughly 514 per million (0 per million in last seven days);
• Iceland, 198,721 cases (2,194 in last seven days), 179 deaths (0 in last seven days), roughly 489 per million (0 per million in last seven days);
• Cayman Islands, 27,966 cases (372 in last seven days), 29 deaths (0 in last seven days), roughly 441 per million (0 per million in last seven days);
• Greenland, 11,971 cases (0 in last seven days), 21 deaths (0 in last seven days), roughly 373 per million (0 per million in last seven days);
• Sao Tome and Principe, 6,079 cases (15 in last seven days), 74 deaths (0 in last seven days), roughly 338 per million (0 per million in last seven days);
• Palau, 5,308 cases (39 in last seven days), 6 deaths (0 in last seven days), roughly 332 per million (0 per million in last seven days);
• Solomon Islands, 21,544 cases (0 in last seven days), 153 deaths (0 in last seven days), roughly 223 per million (0 per million in last seven days);
• Djibouti, 15,690 cases (0 in last seven days), 189 deaths (0 in last seven days), roughly 191 per million (0 per million in last seven days);
• Comoros, 8,209 cases (48 in last seven days), 160 deaths (0 in last seven days), roughly 184 per million (0 per million in last seven days);
• Samoa, 15,134 cases (139 in last seven days), 29 deaths (0 in last seven days), roughly 146 per million (0 per million in last seven days);
• Vanuatu, 11,690 cases (243 in last seven days), 14 death (0 in last seven days), roughly 46 per million (0 per million in last seven days);
• Bhutan, 59,940 cases (116 in last seven days), 21 deaths (0 in last seven days), roughly 27 per million (0 per million in last seven days);
• Burma, 613,760 cases (88 in last seven days), 19,434 deaths (0 in last seven days);
• Montserrat, 1,023 cases (3 in last seven days), 8 deaths (0 in last seven days);
• Saint Barthelemy, 4,845 cases (105 in last seven days), 6 deaths (0 in last seven days);
• Taiwan - province of China, 4,132,429 cases (202,802 in last seven days), 7,780 deaths (652 in last seven days);

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Excess death rates due to pandemic persisted in Western countries

New COVID-19 excess death rate estimates from 47 countries show that rates remained high for 3 consecutive pandemic years.

"Excess mortality has remained high in the Western World for three consecutive years, despite the implementation of COVID-19 containment measures and COVID-19 vaccines. This is unprecedented and raises serious concerns," the authors wrote.  

This is unprecedented and raises serious concerns.

The study , published yesterday in BMJ Public Health , assessed people who died from any cause above and beyond what would normally be expected from January 2020 to December 2022 in 47 countries in Europe, North America, Australia and New Zealand. Death rates were compared to historical death data in each country from 2015 until 2019, and matched by both week and month.  

Death rates 14% higher in 2021

In total, the number of excess deaths in the 47 countries was 3,098,456 from January 1, 2020, until December 31, 2022. In 2020, 1,033,122 excess deaths were recorded, and that number rose in 2021 to 1,256,   942 excess deaths despite containment measures and widespread use of vaccine in Western countries.  

That was 14% more deaths than expected.  

"In 2022, the year in which most containment measures were lifted and COVID-19 vaccines were continued, preliminary available data counts 808,392 excess deaths," the authors wrote.  

Forty-one countries reported excess deaths in 2020, 42 in 2021, and 43 in 2022. The only country to not report excess deaths from 2020 through 2022 was Greenland.   

"Government leaders and policymakers need to thoroughly investigate underlying causes of persistent excess mortality and evaluate their health crisis policies," the authors concluded.  

Avian flu strikes more Minnesota poultry farms

The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) reported two more highly pathogenic avian flu outbreaks in Minnesota, both involving commercial turkey farms in Stearns County, located in the central part of the state.

One facility houses 32,400 turkeys, and the other farm has 43,300 birds. Three other outbreaks were recently reported at turkey farms in the same county. Sporadic outbreaks in poultry flocks continue in the United States, including in Iowa, which reported two recent outbreaks at commercial farms.

More detections in wild birds, mammals

In separate updates, APHIS reported 22 more H5N1 detections in wild birds, several of which were agency-harvested birds in New Mexico's Roosevelt County, which included positive findings in house sparrows, two doves, a tanager, and a grackle. Detections from other states mainly involved raptors found dead, including bald eagles in Maryland, North Carolina, Minnesota, North Carolina, Virginia, and West Virginia.

APHIS also r eported 13 more H5N1 detections in mammals, which mostly involved house mice from New Mexico's Roosevelt County. The new reports included a red fox from New Mexico and a domestic cat from Michigan's Clinton County.

Global mpox activity continues at low level except in DR Congo hot spot

Low-level mpox transmission continues across the world, though reported cases continue to decline, underestimating of the true burden of the disease, the World Health Organization (WHO) said in its latest situation report , which covers illness reported in April.

The WHO received reports of 528 new cases in April, down 21.1% from March. Regions reporting the most cases were the Americas, followed by Africa and Europe. Most of Africa's cases were reported in the Democratic Republic of the Congo (DRC), which is experiencing an ongoing outbreak due to a novel clade 1 virus.

Overall risk is moderate in countries and neighboring countries where mpox has historically circulated and is also moderate for people in the highest-risk groups, including men who have sex with men and sex workers, the WHO said. However, the risk is high for the general population in the DRC.

1 in 4 US adults mistakenly believe MMR vaccine causes autism, survey reveals

Despite no evidence that the measles, mumps, and rubella (MMR) vaccine causes autism, a quarter of US adults still think it does, and the false belief is fueling rising measles cases amid falling vaccination rates, finds a survey by the University of Pennsylvania's Annenberg Public Policy Center (APPC).

"The persistent false belief that the MMR vaccine causes autism continues to be problematic, especially in light of the recent increase in measles cases," APPC Director Kathleen Hall Jamieson, PhD, said in a center  press release . "Our studies on vaccination consistently show that the belief that the MMR vaccine causes autism is associated not simply with reluctance to take the measles vaccine but with vaccine hesitancy in general."

In April 2024, APPC scientists surveyed more than 1,500 adults about measles transmission, symptoms, and vaccination recommendations for pregnant women.

1 in 10 knew vaccine not recommended in pregnancy

In total, 24% of adults said that they don't believe the MMR vaccine doesn't cause autism, and another 3% weren't sure. 

Nearly 6 in 10 participants understood that measles spreads through coughing, sneezing, and touching their face after contact with contaminated surfaces, while more than 1 in 5 (22%) incorrectly said it can be sexually contracted. Only 12% of respondents correctly indicated that an infected person can spread the measles virus for 4 days before a rash appears—12% thought it was 1 week, and 55% weren't sure. 

Only 1 in 10 knew that pregnant women shouldn't receive the measles vaccine because it contains a weakened live form of the virus and therefore may pose a risk to the fetus. 

Fewer than 4 in 10 panelists correctly indicated that measles is a risk factor for premature birth and low birth weight, and only 1 in 10 knew that pregnant women shouldn't receive the measles vaccine because it contains a weakened live form of the virus and therefore may pose a risk to the fetus. 

The Centers for Disease Control and Prevention (CDC) recommends two doses of MMR vaccine for children, with the first dose at 12 to 15 months and the second dose at ages 4 to 6 years. It should also be given to women a month or more before they plan to become pregnant, if they weren't vaccinated as a child.

Shionogi to open new US lab for antibiotic discovery

Japanese drugmaker Shionogi yesterday announced plans to expand its infectious disease and antibiotic research and development (R&D) operations in the United States.

During a panel discussion at the BIO International Convention, Shionogi officials said they plan to establish the company's first US discovery laboratory. The lab will expand the existing R&D facility for San Diego–based Qpex Biopharma, which was acquired by Shionogi in 2023 and has an existing contract with the Biomedical Advanced Research and Development Authority to develop the investigational beta-lactamase inhibitor xeruborbactam.

"We need to address known health threats, including antibiotic-resistant bacteria, as well as prepare for rapidly emerging threats that could lead to future pandemics," Qpex President and CEO Michael Dudley, PharmD, said in a Shionogi  press release . "This is a landmark opportunity to build upon the excellent track record of our organizations in discovering innovative antimicrobial drugs and bringing them to patients."

Shionogi officials say the company's expanded presence in the United States will advance its partnership network with antibiotic researchers in the public and private sector. Shionogi is one of the few large pharmaceutical companies that remains active in antibiotic R&D.

"In the race between antibiotic drug development and increasing resistance, the pathogens are winning," said John Keller, PhD, senior executive officer and senior vice president of the R&D supervisory unit at Shionogi. "If new antibiotics are not discovered and developed, we cannot overcome this public health crisis and are at risk of jeopardizing global health security."

In case you missed it

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Though the test can't pinpoint the virus subtype or source, most of the detections are from states hard hit by H5N1 in dairy herds.

Report: More than 200 symptoms tied to long COVID

The report "offers a comprehensive review of the evidence base for how Long COVID may impact a patient's ability to engage in normal activities."

Report describes emerging sexually transmitted fungal infection

The infection is caused by Trichophyton mentagrophytes type VII, a fungus that may spread via sexual contact.

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The "duckbill" N95 stopped 98% of the virus that causes COVID-19, the authors say.

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Fifty-four people have been hospitalized, with no deaths reported.

FDA panel supports switch to JN.1 for fall COVID vaccines

Though the vote was unanimous, discussions were complicated by the diversity of JN.1 viruses.

Study: Truthful yet misleading Facebook posts drove COVID vaccine reluctance much more than outright lies did

Unflagged vaccine-skeptical content cut vaccination intent by 2.28 percentage points per user, versus −0.05 percentage points for flagged content.

Early use of antivirals linked to reduced risk of long COVID

Early oral antiviral drug administration was associated with a 23% reduction in long COVID overall.

In 2020, 1,033,122 excess deaths were recorded, and that number rose in 2021 to 1,256, 942.

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Child and Teen Firearm Mortality in the U.S. and Peer Countries

Matt McGough , Krutika Amin, Nirmita Panchal , and Cynthia Cox Published: Jul 18, 2023

Editor’s Note: This brief was updated on July 18, 2023, with newer data.

In 2020 and 2021, firearms contributed to the deaths of more children ages 1-17 years in the U.S. than any other type of injury or illness. The child firearm mortality rate has doubled in the U.S. from a recent low of 1.8 deaths per 100,000 in 2013 to 3.7 in 2021.

The United States has by far the highest rate of child and teen firearm mortality among peer nations. In no other similarly large, wealthy country are firearms in the top four causes of death for children and teens, let alone the number one cause. U.S. states with the most gun laws have lower rates of child and teen firearm deaths than states with few gun laws. But, even states with the lowest child and teen firearm deaths have rates much higher than what peer countries experience.

In 2020 and 2021, firearms were involved in the deaths of more children ages 1-17 than any other type of injury or illness, surpassing deaths due to motor vehicles, which had long been the number one factor in child deaths. In 2021, there were 2,571 child deaths due to firearms—a rate of 3.7 deaths per 100,000 children, which is an increase of 68% in the number of deaths since 2000 and 107% since a recent low of 2013.

While the rate of firearm deaths among children has increased since 2000, the rate of motor vehicle deaths is now significantly lower than it had been. The number of motor vehicle deaths among children in 2021 was 49% lower than in 2000, though it did grow during the pandemic by 22% from 2019. Though fewer in number than firearm deaths among children, deaths due to poisonings, which include drug overdoses, have also grown, increasing 186% since 2000 and 103% since 2019.

Provisional CDC data from 2022 indicate that firearms continued to be the number one factor in child deaths for the third year in a row.

Because peer countries’ mortality data are not available for children ages 1-17 years old alone, we group firearm mortality data for teens ages 18 and 19 years old with data for children ages 1-17 years old in all countries for a direct comparison.

On a per capita basis, the firearm death rate among children and teens (ages 1-19) in the U.S. is over 9.5 times the firearm death rate of Canadian children and teens (ages 1-19). Canada is the country with the second-highest child and teen firearm death rate among similarly large and wealthy nations.

As might be expected, teenagers have higher firearm mortality rates than children. In the U.S., teens ages 18 and 19 have a firearm mortality rate of 25.2 per 100,000, compared to a rate of 3.7 per 100,000 for children ages 1-17 in the U.S. Even so, the child firearm mortality rate in the U.S. (3.7 per 100,000 people ages 1-17) is 5.5 times the child and teen mortality rate in Canada (0.6 per 100,000 people ages 1-19).

If the child and teen firearm mortality rate in the U.S. had been brought down to rates seen in Canada, we estimate that approximately 30,000 children’s and teenagers’ lives in the U.S. would have been saved since 2010 (an average of about 2,500 lives per year). This would have reduced the total number of child and teenage deaths from all causes in the U.S. by 13%.

The child and teen (ages 1-19 years) firearm mortality rate varies by state in the U.S. from 2.1 deaths per 100,000 in New York and New Jersey to 17.6 deaths per 100,000 in Louisiana. Even in New York and New Jersey, which have the lowest child and teen firearm mortality rates among those with available data, the rate is still over three times that in Canada.

Because there is no comprehensive national firearm registry, it is difficult to track gun ownership in the U.S. Instead, we look at the correlation between the number of child and teen firearm deaths and the number of gun laws in U.S. states (based on the State Firearm Law Database , which is a catalog of the presence or absence of 134 firearm law provisions across all 50 states).

States with more restrictive firearm laws in the U.S. generally have fewer child and teen firearm deaths than states with fewer firearm law provisions. Even so, these states on average have a much higher rate of child and teen firearm deaths than that of Canada and other countries. Among comparably large and wealthy countries, Canada has the second highest child and teen firearm death rate to the U.S. However, Canada generally has more restrictive firearm laws and regulates access to guns at the federal level. In the U.S., guns may be brought to states with strict laws from out-of-state or unregistered sources .

In 2020 and 2021, firearms were involved in more deaths for children and teens (ages 1-19 years) in the United States than any other type of injury or illness. In 2021, firearms were involved in 4,733 child and teen deaths.

With the exception of Canada, in no other peer country were firearms among the top five causes of childhood and teenage death. Motor vehicle accidents and cancer are the two most common causes of death for this age group in all other comparable countries.

The categories in the chart above are more specific than CDC’s rankable causes of death. We use CDC’s data grouped by injury mechanism and illness. However, given differences in how deaths are grouped by CDC and IHME, we adapt CDC data to be comparable to IHME data. For example, pedestrian deaths are included with motor vehicle and pedestrian deaths in the chart above. See Methods for more details.

Combining all child and teen firearm deaths in the U.S. with those in other OECD countries with above median GDP and GDP per capita, the U.S. accounts for 97% of gun-related child and teen deaths, despite representing 46% of the total population in these countries. Combined, the eleven other similarly large and wealthy countries account for only 153 of the total 4,886 firearm deaths for children and teens ages 1-19 years in these nations, and the U.S. accounts for the remainder.

Firearms account for 20% of all child and teen deaths in the U.S., compared to an average of less than 2% of child and teen deaths in similarly large and wealthy nations.

The U.S. also has the highest rate of each type of child and teen firearm death—suicides, assaults, and unintentional or undetermined intent—among similarly large and wealthy countries.

In 2021 in the U.S., the overall child and teen firearm assault rate was 3.9 per 100,000 children and teens. In the U.S., the overall suicide rate among children and teens was 3.8 per 100,000; and 1.8 per 100,000 child and teen suicide deaths were by firearms. In comparable countries, on average, the overall suicide rate is 2.8 per 100,000 children and teens, and 0.2 per 100,000 children and teens suicide deaths were by firearms.

If the U.S. child and teen suicide by firearm rate was brought down to the same level as in Canada, the peer country with the next highest rate, over 1,000 fewer children and teens would have died in 2021 alone.

The spike in 2020 and 2021 in child and teen firearm deaths in the U.S. was primarily driven by an increase in violent assault deaths. The child and teen firearm assault mortality rate reached a high in 2021 with a rate of 3.9 per 100,000, a 7% increase from the year before and a 50% increase from 2019. The firearm suicide mortality rate among children and teenagers in the U.S. increased 21% from 2019 to 2021.

Exposure and use of firearms also have implications for mental health.  Research suggests that youth may experience symptoms of post-traumatic stress disorder and anxiety in response to gun violence. Specifically, survivors of firearm-related injuries, including youth survivors, may be at increased risk of mental health conditions and substance use disorders. Furthermore, gun violence disproportionately affects many children of color , particularly Black children, and children living in areas with a high concentration of poverty .

• Mental Health
• Global Health Policy
• Gun Violence
• International Comparisons

news release

• U.S. Has the Highest Rate of Gun Deaths for Children and Teens Among Peer Countries

Also of Interest

• Americans’ Experiences With Gun-Related Violence, Injuries, And Deaths
• The Impact of Gun Violence on Children and Adolescents
• States with Firearm Laws Designed to Protect Children
• Deaths Due to Firearms per 100,000 Population by Age
• What is Driving Widening Racial Disparities in Life Expectancy?
• KFF Health News Coverage on Guns

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Maternal death is higher in the U.S. than any other high-income country, study says

More women die from childbirth in the U.S. than any other high-income country.

Black women experience the greatest percentage of deaths and Asian women experienced the least, according to an updated study from the Commonwealth Fund, based on the most recent data from the U.S. Centers for Disease Control and Prevention.

What You Need To Know

More women die from childbirth in the u.s. than any other high-income country, according to an updated study from the commonwealth fund there were about 22 maternal deaths out of every 100,000 live births in the u.s. in 2022 among black women, there were almost 50 maternal deaths out of every 100,000 live births norway had no maternal deaths in 2022.

For their study, researchers looked at differences in maternal mortality, the maternal care workforce and postpartum care in Australia, Canada, Chile, France, Germany, Japan, Korea, the Netherlands, New Zealand, Norway, /Sweden, Switzerland, the United Kingdom and the United States.

In 2022, there were about 22 maternal deaths out of every 100,000 live births in the U.S. While the rate among Black women was more than twice as high, with almost 50 maternal deaths for every 100,000 live births, white and Hispanic mothers in the U.S. also experienced higher maternal death rates than any other country in the study. Asian women had the lowest maternal death rate in the U.S.

The study attributed the high maternal mortality among Black women to worse-quality care compared with whites, including the ability to receive necessary care that is “often rooted in discrimination and clinician bias,” the study said

The U.S. rate was more than double most other high-income countries. Norway had no maternal deaths in 2022. Switzerland, Sweden, the Netherlands, Japan, Australia and Germany all had a maternal death rate of 3.5 or less for every 100,000 live births.

In the U.S., about 20% of maternal deaths occurred during pregnancy, most of them due to heart conditions and stroke.

Nearly two-thirds of the deaths took place up to 42 days after the baby was born. The report found that one week after birth, infection, severe bleeding and high blood pressure were the most common conditions that led to maternal death.

The researchers said women in the U.S. were the least likely to have postpartum support systems, such as guaranteed paid leave or home visits. They also have the fewest midwives and OB-GYNs.

During the pandemic from 2020-2021, maternal death rates increased in four of the countries studied, including the U.S., where the highest increases were among Hispanic women. The Commonwealth Fund cited a study that found almost one third of Latino maternal deaths during that time period were related to COVID-19. The maternal death rate decreased in 2022.

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The Changing Political Geography of COVID-19 Over the Last Two Years

Over the past two years, the official count of coronavirus deaths in the United States has risen and is now approaching 1 million lives. Large majorities of Americans say they personally know someone who has been hospitalized or died of the coronavirus , and it has impacted – in varying degrees – nearly every aspect of life .

A new Pew Research Center analysis of official reports of COVID-19-related deaths across the country, based on mortality data collected by The New York Times, shows how the dynamics of the pandemic have shifted over the past two years.

A timeline of the shifting geography of the pandemic

Pew Research Center conducted this analysis to understand how the geography of the coronavirus outbreak has changed over its course. For this analysis, we relied on official reports of deaths attributed to the novel coronavirus collected and maintained by The New York Times .

The estimates provided in this report are subject to several sources of error. There may be significant differences between the true number of deaths due to COVID-19 and the official reported counts of those deaths. There may also be variation across the states in the quality and types of data reported. For example, most states report deaths based on the residency of the deceased person rather than the location where they died. The New York Times collects data from many different local health agencies, and this likely leads to some additional measurement error.

This analysis relies on county-level data. Counties in the United States vary widely in their population sizes, so in many places in the essay, we divide counties into approximately equal-sized groups (in terms of their population) for comparability or report on population adjusted death rates rather than total counts of deaths.

The pandemic has rolled across the U.S. unevenly and in waves. Today, the death toll of the pandemic looks very different from how it looked in the early part of 2020 . The first wave (roughly the first 125,000 deaths from March 2020 through June 2020) was largely geographically concentrated in the Northeast and in particular the New York City region. During the summer of 2020, the largest share of the roughly 80,000 deaths that occurred during the pandemic’s second wave were in the southern parts of the country.

The fall and winter months of 2020 and early 2021 were the deadliest of the pandemic to date. More than 370,000 Americans died of COVID-19 between October 2020 and April 2021; the geographic distinctions that characterized the earlier waves became much less pronounced.

By the spring and summer of 2021, the nationwide death rate had slowed significantly, and vaccines were widely available to all adults who wanted them. But starting at the end of the summer, the fourth and fifth waves (marked by new variants of the virus, delta and then omicron) came in quick succession and claimed more than 300,000 lives.

In many cases, the characteristics of communities that were associated with higher death rates at the beginning of the pandemic are now associated with lower death rates (and vice versa). Early in the pandemic, urban areas were disproportionately impacted. During the first wave, the coronavirus death rate in the 10% of the country that lives in the most densely populated counties was more than nine times that of the death rate among the 10% of the population living in the least densely populated counties. In each subsequent wave, however, the nation’s least dense counties have registered higher death rates than the most densely populated places.

Despite the staggering death toll in densely populated urban areas during the first months of the pandemic (an average 36 monthly deaths per 100,000 residents), the overall death rate over the course of the pandemic is slightly higher in the least populated parts of the country (an average monthly 15 deaths per 100,000 among the 10% living in the least densely populated counties vs. 13 per 100,000 among the 10% in the most densely populated counties).

As the relationship between population density and coronavirus death rates has changed over the course of the pandemic, so too has the relationship between counties’ voting patterns and their death rates from COVID-19.

In the spring of 2020, the areas recording the greatest numbers of deaths were much more likely to vote Democratic than Republican. But by the third wave of the pandemic, which began in fall 2020, the pattern had reversed: Counties that voted for Donald Trump over Joe Biden were suffering substantially more deaths from the coronavirus pandemic than those that voted for Biden over Trump. This reversal is likely a result of several factors including differences in mitigation efforts and vaccine uptake, demographic differences, and other differences that are correlated with partisanship at the county level.

During this third wave – which continued into early 2021 – the coronavirus death rate among the 20% of Americans living in counties that supported Trump by the highest margins in 2020 was about 170% of the death rate among the one-in-five Americans living in counties that supported Biden by the largest margins.

As vaccines became more widely available, this discrepancy between “blue” and “red” counties became even larger as the virulent delta strain of the pandemic spread across the country during the summer and fall of 2021, even as the total number of deaths fell somewhat from its third wave peak.

During the fourth wave of the pandemic, death rates in the most pro-Trump counties were about four times what they were in the most pro-Biden counties. When the highly transmissible omicron variant began to spread in the U.S. in late 2021, these differences narrowed substantially. However, death rates in the most pro-Trump counties were still about 180% of what they were in the most pro-Biden counties throughout late 2021 and early 2022.

The cumulative impact of these divergent death rates is a wide difference in total deaths from COVID-19 between the most pro-Trump and most pro-Biden parts of the country. Since the pandemic began, counties representing the 20% of the population where Trump ran up his highest margins in 2020 have experienced nearly 70,000 more deaths from COVID-19 than have the counties representing the 20% of population where Biden performed best. Overall, the COVID-19 death rate in all c ounties Trump won in 2020 is substantially higher than it is in counties Biden won (as of the end of February 2022, 326 per 100,000 in Trump counties and 258 per 100,000 in Biden counties).

Partisan divide in COVID-19 deaths widened as more vaccines became available

Partisan differences in COVID-19 death rates expanded dramatically after the availability of vaccines increased. Unvaccinated people are at far higher risk of death and hospitalization from COVID-19, according to the Centers for Disease Control and Prevention, and vaccination decisions are strongly associated with partisanship . Among the large majority of counties for which reliable vaccination data exists, counties that supported Trump at higher margins have substantially lower vaccination rates than those that supported Biden at higher margins.

Counties with lower rates of vaccination registered substantially greater death rates during each wave in which vaccines were widely available.

During the fall of 2021 (roughly corresponding to the delta wave), about 10% of Americans lived in counties with adult vaccination rates lower than 40% as of July 2021. Death rates in these low-vaccination counties were about six times as high as death rates in counties where 70% or more of the adult population was vaccinated.

More Americans were vaccinated heading into the winter of 2021 and 2022 (roughly corresponding to the omicron wave), but nearly 10% of the country lived in areas where less than half of the adult population was vaccinated as of November 2021. Death rates in these low-vaccination counties were roughly twice what they were in counties that had 80% or more of their population vaccinated. ( Note: The statistics here reflect the death rates in the county as a whole, not rates for vaccinated and unvaccinated individuals, though individual-level data finds that death rates among unvaccinated people are far higher than among vaccinated people.)

This analysis relies on official reports of deaths attributed to COVID-19 in the United States collected and reported by The New York Times .

COVID-19 deaths in Puerto Rico and other U.S. territories are not included in this analysis. Additionally, deaths without a specific geographic location have been excluded.

Data was pulled from the GitHub repository maintained by The New York Times on March 1, 2022, and reflects reported coronavirus deaths through Feb. 28.

There are several anomalies in the deaths data. Many locales drop off their reporting on the weekends and holidays. In addition to the rhythm of the reporting cycle, there are many instances where a locality will revise the count of its deaths downward (usually only by a small amount) or release a large batch of previously unreported deaths on a single day. The downward revisions were identified and retroactively applied to earlier days.

Large batches of cases were identified by finding days that increased by more than 10 deaths and were 10 standard deviations above the norm for a county within a 30-day window. Deaths reported in these anomalous batches were then evenly distributed across the days leading up to when they were released.

Population data for U.S. counties comes from the 2015-2019 American Community Survey estimates published by the Census Bureau (accessed through the tidycensus package in R on Feb. 21). The 2020 vote share for each county was purchased from Dave Leip’s Election Atlas (downloaded on Nov. 21, 2021).

The analysis looks at deaths among counties based on their 2020 vote. Counties were grouped into five groups with approximately equal population. For analyses that include 2020 vote, Alaskan counties are excluded because Alaska does not report its election results at the county level. The table below provides more details.

This essay benefited greatly from thoughtful comments and consultation with many individuals around Pew Research Center. Jocelyn Kiley, Carroll Doherty and Jeb Bell provided invaluable editorial guidance. Peter Bell and Alissa Scheller contributed their expertise in visualization, Ben Wormald built the map animation, and Reem Nadeem did the digital production. Andrew Daniller provided careful attention to the quality check process, and David Kent’s watchful copy editing eye brought clarity to some difficult concepts.

Lead photo: Kent Nishimura/Los Angeles Times via Getty Images

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