Another doubling of excess mortality in the United States relative to its European peers between 2017 and 2021

Abstract

Importance Previous studies have shown the pre-pandemic emergence of a gap in mortality between the United States and other high-income nations. This gap was estimated to account for nearly one in seven US deaths in 2017. Objective The number and proportion of US deaths that can be attributed to this gap is expected to have grown during the pandemic. This study aims at quantifying this growth at the end of 2021. Design This cross-sectional study uses publicly available 2017 to 2021 data on deaths from all causes and 2020-2021 Covid-19 death counts in the United States and five European countries. Number of deaths are combined with publicly available estimates of population size by sex and age group in these European countries to produce sex- and age-specific mortality rates. These rates are averaged and applied to the US population by sex and age-group to compare the resulting and actual US death counts. Setting The United States and the five most populous countries in Western Europe. Participants All deceased individuals in these countries are included in the death counts. This study does not use individual records. Intervention None. Main Outcome and Measure Total number of US deaths and their counterfactuals when substituting average sex- and age-specific mortality rates for the European countries to those that prevailed in the United States. Results The counterfactuals reveal 711,109 to 747,783 excess deaths in the United States in 2021, amounting to 20.8% to 21.7% of all US deaths that year (3,426,249). Excess deaths increased by 320,436 to 331,477 between 2017 and 2021, 80.0% to 82.7% more than the 2017 estimate. A decomposition of the lower figure showed that population change contributed little to the 2017-2021 increase in excess deaths (33,545 additional deaths). Covid-19 mortality alone continue contributed 230,672 excess deaths in 2021, more than 2020, whereas other causes of deaths contributed 56,219 more excess deaths in 2021 than in 2017. Discussion The proportion of US deaths that would be avoided if the United States could achieve the mortality of its West European counterparts surged to more than one in five during the pandemic. The large and still growing contribution of Covid-19 to excess mortality in the United States is consistent with vaccination rates plateauing at lower levels than in European countries. The overall increase in mortality from other causes during the pandemic increasingly separates the United States from West European countries as well.

Excess all-cause mortality in the USA and Europe during the COVID-19 pandemic, 2020 and 2021

“…Another recent study found that if the USA had the same age-specific mortality rates as other wealthy nations in 2019, there would have been 626,353 fewer deaths, with over half of these deaths occurring in people under 65 years of age 24 . These differences have grown during the pandemic 24 , 26 , with one recent analysis finding that approximately 1.1 million deaths in the USA, including half of deaths in people under 65 years, could have been averted in 2021 had age-specific mortality rates matched those of other wealthy countries 24 . The drivers of these long-standing differences in baseline mortality rates between the USA and other wealthy countries are complex, but include factors such as increasing drug overdose and suicide mortality as well as a plateau in heart disease mortality among other causes of death, with widening educational inequalities in mortality seen in the USA over the past several decades relative to other peer nations 25 .…”

Missing Americans: Early Death in the United States, 1933-2021

“…“Missing Americans” offers an alternative, easily interpretable metric: the number of U.S. deaths that would have been averted if the U.S. had the age-specific mortality rates of its peers. Our analysis builds on our (14) and others’ (11, 12) previous analyses documenting excess U.S. deaths prior to COVID-19 and during the pandemic (19), as well as work on racial disparities in excess deaths before (14, 29) and during the COVID-19 pandemic (22, 23, 30).…”

“…Our comparator set makes comprehensive use of available data on peer countries, following recent work on life expectancy trends (4,26). However, we also present "Missing Americans" estimates using two alternate comparators: the other Group of Seven (G7) countries -Canada, France, Germany, Italy, Japan, and the United Kingdom -used in prior work by members of this study team, (14) and the five largest Western European countries -France, Germany, Italy, Spain, UK -used by Preston and Vierboom (11) and Heuveline (19). Data on deaths and population denominators were obtained from the HMD, which compiles official data from national vital registries and censuses.…”

“…In this paper, we quantify the number of "Missing Americans" from 1933 through 2021 -the number of deaths that would have been averted each year if U.S. mortality rates had equaled those of other wealthy countries. We extend prior analyses (11,12,14,19) in three directions. First, we contextualize the COVID-19 pandemic within long-term historical trends, computing excess U.S. deaths starting in 1933 (when the U.S. mortality series begins).…”

The impact of COVID‐19 shelter‐in‐place policy responses on excess mortality

“…In one study, fixed effects models show state-level SIP policies did not impact excess mortality in the U.S. (Pugh et al, 2022). Additional studies in the U.S. have examined the impact of SIP policies on the number of COVID-19 outcomes including cases, hopsitalizations and deaths (Berry et al, 2021;Courtemanche et al, 2020;Dave, McNichols, & Sabia, 2021, 2022Lyu & Wehby, 2020). Similarly, other studies explored the relationship between the number of COVID-19 cases and deaths and the enactment of SIP policies (Jalloh et al, 2022).…”