Children and Youth Nearly Twice as Likely to Die in the South as in New England

May 10, 2023

The mortality rate for children and youth in the Southeastern 1 region of the United States was nearly twice (1.8 times) the rate in New England over 2020 and 2021 (Figure 1). The Southeastern states had the highest rates by region over this period, 78.6 deaths per 100,000. The New England states had the lowest rate, 43.1 deaths per 100,000.

This regional disparity worsened over the COVID-19 pandemic years. The Southeastern child and youth mortality rate increased 9.2 points from 2018-2019 to 2020-2021, but it only increased 1.4 points in New England. For the two years prior to the pandemic, the rate in the Southeastern states was 1.7 times the New England rate, but for the first two pandemic years, it increased to 1.8 times.

Figure 1

Among the states, Mississippi had the highest rate in 2020-2021, 108.6 deaths per 100,000 (Figure 2). Mississippi’s rate was nearly three (2.9) times the state with the lowest rate, Massachusetts, which had a rate of 37.3. Louisiana, at 100.2, and Alabama, at 90.4, had the second and fourth highest rates respectively. (Alaska had the third highest rate at 94.3.) The Southeastern states of South Carolina, Arkansas, Tennessee, and Kentucky also were among the states with the top ten highest child and youth mortality rates. 

Figure 2


The United States as a whole has a high mortality rate compared to other rich countries. While life expectancy rates have begun to increase again since the start of the pandemic in other rich countries, life expectancy continues to decline in the United States. Children in the United States are not spared from the high U.S. mortality rate. UNICEF reports, “[a]mong the richer countries in our list [of 41 countries], the United States stands out,” because “[i]t has a higher child mortality rate than countries with similar levels of per capita income.”

To reduce U.S. mortality rates, the United States — and particularly the Southeastern states — needs to address its high rates of poverty and economic inequality, which are important social determinants of health outcomes. The country as a whole also needs to move toward universal access to health care and to invest more in policies promoting improved public health. 

  1. This article uses Bureau of Economic Analysis regional definitions. New England: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont. Mideast: Delaware, District of Columbia, Maryland, New Jersey, New York, Pennsylvania. Great Lakes: Illinois, Indiana, Michigan, Ohio, Wisconsin. Plains: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota. Southeast: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, West Virginia. Southwest: Arizona, New Mexico, Oklahoma, Texas. Rocky Mountain: Colorado, Idaho, Montana, Utah, Wyoming. Far West: Alaska, California, Hawaii, Nevada, Oregon, Washington.

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