Another doubling of excess mortality in the United States relative to its European peers between 2017 and 2021

  1. Patrick Heuveline

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Abstract

A mortality gap between the United States and other high-income nations emerged before the pandemic. International comparisons of Covid-19 mortality suggest this gap might have increased during the pandemic.

Applying average mortality rates of the five largest West European countries to the US population shows that the number of “excess deaths” attributable to this mortality gap continues to increase year after year in the United States. The annual number of such excess deaths has doubled between 2017 and 2021, with most of the increase occurring during the pandemic (+89.1% between 2019 and 2021). In 2021, excess mortality in the United States relative to its European peers contributed 892,491 excess deaths, amounting to 25.8% of all US deaths that year, up from 15.7% in 2017.

Of the 450,224 excess deaths added between 2017 and 2021, 42,317 are attributable to population change (9.4%), 230,672 to differential rates of Covid-19 mortality (51.2%), and the remaining 177,235 to differential rates of mortality from other causes (39.4%, possibly including misclassified deaths due to Covid-19). The contribution of Covid-19 mortality to excess mortality in the United States (relative to its European peers) grew between 2020 and 2021 due to diverging trends in Covid-19 mortality, especially towards the end of 2021 as US vaccination rates plateaued at lower levels than in European countries. While this contribution might be transient, divergent trends in mortality from other causes persistently separates the United States from West European countries. Excess mortality is particularly high between ages 15 and 64. In 2021, nearly half of all US deaths in this age range are excess deaths (48.0%).

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  1. Version published to 10.1101/2022.03.21.22272722v3 on medRxiv
  2. Version published to 10.1101/2022.03.21.22272722v2 on medRxiv
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    SciScore for 10.1101/2022.03.21.22272722: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

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    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  4. Version published to 10.1101/2022.03.21.22272722v1 on medRxiv