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Disparities in premature deaths raise Medicare equity issues

With higher premature death rates, researchers raise health equity concerns for Black adults who might never see Medicare benefits despite paying into the program.

Sara Heath
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Published: 10 Nov 2025

Black adults have a 35% higher premature death rate compared to White adults, a trend researchers said in JAMA Health Forum should raise concerns about health equity in certain benefits, like Medicare coverage.

All working adults help finance the Medicare program through payroll tax contributions with the expectation that those adults will access Medicare benefits when they turn 65. But if certain populations are at higher risk for premature death, they might not ever see those Medicare benefits, despite paying into them.

This creates some health equity concerns, the researchers said.

Black adults have higher premature death rates

Using Centers for Disease Control and Prevention (CDC) National Vital Statistics System microdata and CDC WONDER population estimates, the researchers calculated risk for premature death, defined as death between age 18-64.

Overall, premature death rates rose in the United States between 2012 and 2022, regardless of race. In 2012, there were 243 premature deaths per 100,000 adults. By 2022, that number grew 27.2% to 309 premature deaths per 100,000 adults.

That increase might have been driven by disproportionate increase in premature deaths among Black adults, the researchers added.

In 2012, there were 309 premature deaths per 100,000 adults compared to 247 premature deaths for White individuals. That's a disparity of 62 deaths, or 25%, for Black individuals.

By 2022, that gap widened. There were 427 deaths per 100,000 adults among Black people, compared to 316 deaths among White people. That's a gap of 111 deaths, or 35%, for Black people.

Perhaps more striking is the disparity in rate of change, the researchers said. Over the decade, Black adults saw a 38.2% increase in premature deaths. That's compared to a 27.7% increase among White populations.

Raising health equity concerns

According to the researchers, these results could flag some health equity issues.

"These results raise concerns about structural inequities within the Medicare entitlement and financing system," they stressed. "Despite contributing to Medicare throughout their working lives, Black individuals in the U.S. are less likely to live long enough to reach the qualifying age for coverage."

Notably, these health equity concerns are not a call to reconsider Medicare financing structures, the researchers emphasized. Rather, the healthcare industry must identify the drivers of premature deaths across Black populations.

"This study highlights the need to confront structural inequities driving early mortality and to reconsider Medicare eligibility and health financing for populations with differing life expectancies," they explained.

It wasn't just Black populations who saw disparities.

The research also flagged some state-based disparities in premature death. Mississippi and West Virginia had the highest premature death rates, while Minnesota and Massachusetts had the lowest. Race-based disparities persisted in nearly every state except New Mexico, Rhode Island and Utah.

The researchers recommended further examination of health policies, such as healthcare coverage and social determinants of health work, that enable access to medical care prior to age 65.

"Reducing rising premature mortality and racial disparities, particularly among Black individuals, will require coordinated health and social policy reforms that ensure timely and equitable access to affordable health care coverage before 65 years of age, including access to Medicaid and private insurance, alongside sustained investments in factors that shape long-term health, such as housing, education and income security," the researchers concluded.

Sara Heath has covered news related to patient engagement and health equity since 2015.

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