All-cause mortality in US soars 23% in 9-month period, largely due to COVID-19

In the United States, excess deaths increased 22.9% between March 1, 2020, and Jan. 2, 2021, an increase that “far exceeds annual increases observed in recent years” of 2.5% or less, data in JAMA show.

Researchers attributed 72.4%, or 522,368, of the excess deaths during the study period to COVID-19.

Steven H. Woolf, MD, MPH, a professor of family medicine and director of the Virginia Commonwealth University School of Medicine Center on Society and Health, and colleagues analyzed mortality data from 2014 to 2019 to forecast the number of expected deaths in 2020. The researchers also analyzed provisional, unweighted death counts for the District of Columbia and 49 states from March 1, 2020, to Jan. 2, 2021. North Carolina, which did not have enough data, was not included in the analysis.

The data were organized into different geographic areas and included all deaths in which non-COVID-19 conditions were recorded as the underlying cause of death, as well as deaths where COVID-19 was indicated as an “underlying or contributing cause.”

California, Texas, New York, Florida and Pennsylvania had the highest number of total excess deaths, whereas Wyoming, Maine, Alaska, Vermont and Hawaii had the fewest. The 10 states with the highest per capita rate of excess deaths were Mississippi, New Jersey, New York, Arizona, Alabama, Louisiana, South Dakota, New Mexico, North Dakota and Ohio, according to the report. Woolf and colleagues reported that excess deaths surged in the East in April, followed by extended summer and early winter surges in southern and western states, respectively. The researchers noted that many of these states “weakly embraced, or discouraged, pandemic control measures and lifted restrictions earlier than other states.”

“They said they were opening early to rescue the economy,” Woolf said in a press release. “The tragedy is that policy not only cost more lives, but actually hurt their economy by extending the length of the pandemic. One of the big lessons our nation must learn from COVID-19 is that our health and our economy are tied together. You can’t really rescue one without the other.”

The excess death rate during the period studied was higher among non-Hispanic Black individuals (208.4 deaths per 100,000) than non-Hispanic white individuals (157 deaths per 100,000) or Hispanic individuals (139.8 deaths per 100,000). Respectively, these groups made up 16.9%, 61.1% and 16.7% of excess deaths, according to the researchers. They also noted that the percentage of excess deaths among non-Hispanic Black individuals surpassed their proportion of the U.S. population (12.5%). Woolf said in the press release that the findings are consistent with other reports indicating racial disparity among victims of COVID-19.

The report “also indicates that excess deaths from some conditions other than COVID-19 are also occurring at higher rates in the African American population,” he said.

In the press release, Woolf said 28% of the nation’s excess deaths may have been caused by factors such as a person not seeking or finding adequate care for conditions such as myocardial infarction, diabetes or a behavioral health crisis that led to suicide or drug overdose.

“All three of those categories could have contributed to an increase in deaths among people who did not have COVID-19 but whose lives were essentially taken by the pandemic,” he said.

Woolf and colleagues’ new analysis updates an earlier report by the same research team that found U.S. mortality rose 20% from March 2020 to July 2020. According to the researchers, that earlier finding was “only partly explained by COVID-19.” The new report also follows provisional data from the CDC that showed COVID-19 accounted for an estimated 11.3% of the deaths in the U.S. in 2020, making it the third leading cause of death after heart disease and cancer.

In a related editorial, Alan M. Garber, MD, PhD, chief academic officer at Harvard University, wrote that Woolf and colleagues’ findings illustrate that “despite the scientific, medical and public health progress of recent decades, the loss of life attributable to the COVID-19 pandemic exceeds the mortality of major wars.” He also said that no country “should squander this opportunity to do what it takes to prepare” for subsequent pandemics.

“Failure to anticipate the scale of the potential damage from such future catastrophes will only exacerbate the tendency to downplay their importance, making it less likely that governments will prepare adequately,” Garber wrote. “That is why understanding the toll of a pandemic is an important step in the right direction.”

References:

Garber AM. JAMA. 2021;doi:10.1001/jama.2021.5120.

Woolf SH, et al. JAMA. 2021;doi:10.1001/jama.2021.5199.