Infectious Disease

All-cause mortality in the US increases 23% in 9 months, mainly due to COVID-19

April 02, 2021

3 min read

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Disclosure:
Garber reports that outside of the work submitted, he has received personal fees from Exelixis and Vertex Pharmaceuticals and serves as the director and chairman of the Center for Advanced Biological Innovation and Manufacturing. Woolf and colleagues do not report any relevant financial information.

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In the United States, excessive deaths rose 22.9% between March 1, 2020 and January 2, 2021, an increase “far exceeding the annual increases of 2.5% or less seen in recent years” as data in JAMA show.

The researchers attributed 72.4% or 522,368 of the excessive deaths during the study period to COVID-19.

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

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

The data was broken down into different geographic areas and included all deaths for which non-COVID-19 conditions were recorded as the underlying cause of death and deaths for which COVID-19 was stated as “underlying or contributing cause”.

California, Texas, New York, Florida, and Pennsylvania had the most deaths, while Wyoming, Maine, Alaska, Vermont, and Hawaii had the fewest. The 10 states with the highest per capita death rates, according to the report, were Mississippi, New Jersey, New York, Arizona, Alabama, Louisiana, South Dakota, New Mexico, North Dakota and Ohio. Woolf and colleagues reported that April saw more deaths in the east, followed by extensive summer and early winter floods in the southern and western states, respectively. The researchers found that many of these states “were weakly in favor of or against measures to combat pandemics and lifted restrictions earlier than other states”.

“They said they would open early to save the economy,” Woolf said in a press release. “The tragedy is that politics not only cost more lives but also damage their economies by prolonging the duration of the pandemic. One of the great lessons our nation must learn from COVID-19 is that our health and our economies are interconnected. You can’t really save one without the other. “

The excessive death rate during the period studied was higher in non-Hispanic black people (208.4 deaths per 100,000) than non-Hispanic white people (157 deaths per 100,000) or Hispanic people (139.8 deaths per 100,000). According to the researchers, these groups accounted for 16.9%, 61.1% and 16.7% of the excessive deaths. They also found that the percentage of excessive deaths among non-Hispanic blacks exceeded their share of the US population (12.5%). Woolf said in the press release that the results are in line with other reports pointing to racial differences between victims of COVID-19.

The report “also shows that excessive deaths from conditions other than COVID-19 are also more common in the African American population,” he said.

In the press release, Woolf said that 28% of the country’s excessive deaths may have been caused by factors such as a person failing to seek or find adequate care for conditions like myocardial infarction, diabetes, or a behavioral health crisis that led to suicide or overdose.

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

Woolf and colleagues’ new analysis updates an earlier report by the same research team that found that US mortality rose 20% from March 2020 to July 2020. According to the researchers, this earlier finding was “only partially explained by COVID-19”. The new report also follows preliminary data from the CDC, which shows that COVID-19 accounted for an estimated 11.3% of deaths in the United States in 2020. This makes COVID-19 the third leading cause of death after heart disease and cancer.

In a related editorial Alan M. Garber, MD, PhD, Harvard University Academic Director wrote that Woolf and colleagues’ findings show that “despite advances in science, medicine, and health over the past few decades, the loss of life caused by the COVID-19 pandemic exceeds mortality from major wars.” He also said no country “should miss this opportunity to do what is necessary to prepare for subsequent pandemics”.

“Failure to foresee the magnitude of the potential harm from such future disasters will only reinforce the tendency to downplay their importance, making it less likely that governments would adequately prepare,” Garber wrote. “That is why it is an important step in the right direction to understand the consequences of a pandemic.”

References:

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

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

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