The author of a study on hospitals in the US Pacific territories says she hopes it will spur policy makers to consider ways to improve healthcare in the islands.
The study found that in 57 territorial hospitals, mortality rates were 18.8 percent, compared to 16 percent in nearly 5,000 stateside hospitals.
About five million people live in the US territories, which include Puerto Rico, the Virgin Islands, along with Guam, CMNI and American Samoa.
The researcher, Dr Marcella Nunez-Smith, an Assistant Professor of Medicine at Yale school of medicine, says they were stunned at the level of the disparity.
"That is a substantial number of people, and very importantly, these are people who, by and large, are really going to have to get care where they live, because of the geographic distance from other communities, making it really important to make sure the quality of care locally is very strong."
Dr Marcella Nunez-Smith