COVID-19 and Excess All-Cause Mortality in the US and 18 Comparison Countries

“We compared US COVID-19 deaths and excess all-cause mortality in 2020 (vs 2015-2019) to that of 18 countries with diverse COVID-19 responses.

We compared the US to Organisation for Economic Co-operation and Development countries with populations exceeding 5 million and greater than $25 000 per capita gross domestic product. For each country, we calculated the COVID-19 per capita mortality rate and grouped countries by mortality: (1) low (COVID-19 deaths, <5/100,000), (2) moderate (5-25/100,000), and (3) high (>25/100,000). We used Poisson regression for comparisons across countries.

[..] In the 14 countries with all-cause mortality data, the patterns found for COVID-19–specific deaths were similar for excess all-cause mortality [table below]. In countries with moderate COVID-19 mortality, excess all-cause mortality remained negligible throughout the pandemic. In countries with high COVID-19 mortality, excess all-cause mortality reached as high as 102.1/100,000 in Spain, while in the US it was 71.6/100,000. However, since May 10 and June 7, excess all-cause mortality was higher in the US than in all high-mortality countries [table below].

Excess All-Cause Mortality in the US Compared With That in Other Countries

[..] After the first peak in early spring, US death rates from COVID-19 and from all causes remained higher than even countries with high COVID-19 mortality. This may have been a result of several factors, including weak public health infrastructure and a decentralized, inconsistent US response to the pandemic.

Limitations of this analysis include differences in mortality risk: the US population is younger but has more comorbidities compared with the other countries. In addition, since late August death rates have increased in several countries, and how mortality will compare with the US throughout fall remains unknown.”

Full article, Bilinski A and Emanuel EJ. JAMA 2020.10.12