Just How Much Was 2020 an Outlier for Deaths? thumbnail

Just How Much Was 2020 an Outlier for Deaths?

No harder measure of the coronavirus pandemic’s toll exists: death from any cause rose 23% nationwide in 2020.

That meant 522,368 excess deaths from March through the end of 2020 compared with a projection from the prior 5 years, Steven Woolf, MD, MPH, of Virginia Commonwealth University School of Medicine in Richmond, and colleagues reported in JAMA.

It’s well above the unofficial tally of COVID-19 deaths, which reached about 339,000 deaths by the end of 2020. COVID directly accounted for about 72% of the excess mortality, Woolf’s group found.

The rest might have been “either immediate or delayed mortality from undocumented COVID-19 infection, or non–COVID-19 deaths secondary to the pandemic, such as from delayed care or behavioral health crises,” they suggested.

Notably, heart disease, diabetes, and Alzheimer disease deaths increased during surges in their data. That data came from provisional, unweighted death counts for the District of Columbia and all the states except North Carolina (due to insufficient data) from the National Center for Health Statistics and the U.S. Census Bureau.

A prior analysis by the group through July 2020 had suggested a 20% increase in excess deaths for the early period of the pandemic.

New York, ravaged by that early surge, had the largest relative excess — 38% above expected; but Mississippi and New Jersey beat it for per capita rate of excess mortality. All regions of the U.S. beat expectations.

As previously reported, the non-Hispanic Black population sustained the biggest excess mortality per capita, outpacing their proportion of the population (16.9% of excess deaths vs 12.5% of the population).

“There is no more visible or alarming manifestation of the toll of the COVID-19 pandemic than the deaths it has caused,” Alan Garber, MD, PhD, of Harvard University in Boston, wrote in an accompanying editorial.

While it’s hard to compare directly due to different methods, “it seems likely that COVID-19 will have contributed to nearly as many deaths in the U.S. as the great influenza pandemic of 1918, and more than in any influenza outbreak in the U.S. since then,” as well as surpassing that of major wars, he wrote.

But those depressing statistics also show just how much society stands to gain by preparing for the next pandemic, he noted. “The U.S. and other countries are most likely to learn from the pandemic if they understand the consequences of failure…. No nation should squander this opportunity to do what it takes to prepare for the next one.”

Disclosures

The authors received partial funding from the NIH’s National Center for Advancing Translational Sciences.

The researchers reported no relevant disclosures.

Garber disclosed personal fees from Exelixis and from Vertex Pharmaceuticals, as well as uncompensated roles with the Center for Advanced Biological Innovation and Manufacturing.

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