Research reveals 'striking' number of excess deaths in US

Key takeaways:

• The United States has significantly higher death rates compared with similarly high-income European countries.
• The COVID-19 pandemic worsened the number of excess deaths.

The United States continues to have significantly higher excess death rates compared with similarly high-income European countries, and this gap widened during the pandemic, according to study results published in PLoS One.

Patrick Heuveline, PhD, a faculty associate director of the California Center for Population Research at UCLA, wrote that previous research has indicated that, between 2000 and 2017, there was a substantial mortality gap between the United States and five high-income European countries: England and Wales, France, Germany, Italy and Spain (34.8% higher).

Heuveline wrote that the most salient measure of the gap in mortality between the U.S. and other high-income nations is the number of excess deaths, which can be estimated by subtracting a counterfactual number of deaths obtained after replacing the prevailing sex- and age-specific mortality rates with more favorable rates from the actual number of deaths.

“A previous study tracked the annual number of excess deaths in the United States from 2000 to 2017 by estimating how many fewer deaths would have occurred had the country faced the same mortality rates as a composite of the five largest Western European countries,” Heuveline wrote.

He added that his study expands on previous research “by extending the estimation of the annual number of U.S. excess deaths relative to the same five European countries from 2017 to 2021, and of the specific contribution of differences in COVID-19 mortality from April 1, 2021, to the end of 2021.”

“With a combined population size very similar to that of the United States, these five countries provide a realistic benchmark for a large, diverse, and wealthy nation,” he wrote. “The results were striking.”

After applying population-weighted average mortality rates of the five largest West European countries to the U.S. population, Hueveline found that the mortality gap increased the number of U.S. deaths by 34.8% in 2021, resulting in 892,491 excess deaths that year.

When controlling for population size, he wrote, the annual number of excess deaths is up 84.9% between 2019 and 2021. In other words, the number of excess deaths each year almost doubled.

Hueveline wrote that “diverging trends” in COVID-19 mortality was a factor to the increase of excess deaths, particularly near the end of 2021 as U.S. vaccination levels flattened and were lower than those in European countries.

A quarter of all excess deaths in the U.S. in 2021 were attributed to COVID-19 — 223,266 deaths out of 892,491 total. However, Hueveline noted that 45.5% of the population-standardized increase in excess deaths between 2019 and 2021 were attributable to causes of death that were not COVID-19.

Though COVID-19’s contribution to excess mortality “might be transient,” Heueveline wrote trends in mortality from other causes persist. Specifically, he noted that excess mortality is particularly high for those aged 15 to 64 years. In fact, nearly half of all U.S. deaths in this age range in 2021 — 47.5% — were excess deaths. To put it another way, “the number of U.S. adult deaths was 90.6% higher than it would have been in the absence of ‘excess deaths’ in 2021,” he wrote.