Impact of Population Growth and Aging on Estimates of Excess U.S. Deaths During the COVID-19 Pandemic, March to August 2020

• Published in: Annals of Internal Medicine 2021-04
• Main Authors: Shiels, Meredith S, Almeida, Jonas S, García-Closas, Montserrat, Albert, Paul S, Freedman, Neal D, Berrington de González, Amy
• Format: Article
• Language: English
• DOI: 10.7326/M20-7385

Visual Abstract. Impact of Population Growth and Aging on Excess U.S. Deaths During COVID-19 Estimates of excess mortality during the COVID-19 pandemic provide an important metric for quantifying deaths due to COVID-19 as well as those indirectly caused by it. This study updates recent estimates for excess mortality by accounting for the aging of the population. * Download figure * Download PowerPoint Abstract Background: Excess death estimates quantify the full impact of the coronavirus disease 2019 (COVID-19) pandemic. Widely reported U.S. excess death estimates have not accounted for recent population changes, especially increases in the population older than 65 years. Objective: To estimate excess deaths in the United States in 2020, after accounting for population changes. Design: Surveillance study. Setting: United States, March to August 2020. Participants: All decedents. Measurements: Age-specific excess deaths in the United States from 1 March to 31 August 2020 compared with 2015 to 2019 were estimated, after changes in population size and age were taken into account, by using Centers for Disease Control and Prevention provisional death data and U.S. Census Bureau population estimates. Cause-specific excess deaths were estimated by month and age. Results: From March through August 2020, 1 671 400 deaths were registered in the United States, including 173 300 COVID-19 deaths. An average of 1 370 000 deaths were reported over the same months during 2015 to 2019, for a crude excess of 301 400 deaths (128 100 non–COVID-19 deaths). However, the 2020 U.S. population includes 5.04 million more persons aged 65 years and older than the average population in 2015 to 2019 (a 10% increase). After population changes were taken into account, an estimated 217 900 excess deaths occurred from March through August 2020 (173 300 COVID-19 and 44 600 non–COVID-19 deaths). Most excess non–COVID-19 deaths occurred in April, July, and August, and 34 900 (78%) were in persons aged 25 to 64 years. Diabetes, Alzheimer disease, and heart disease caused the most non–COVID-19 excess deaths. Limitation: Provisional death data are underestimated because of reporting delays. Conclusion: The COVID-19 pandemic resulted in an estimated 218 000 excess deaths in the United States between March and August 2020, and 80% of those deaths had COVID-19 as the underlying cause. Accounting for population changes substantially reduced the excess non–COVID-19 death estimates, providing importan