The Covid-19 pandemic and the expansion of the mortality gap between the United States and its European peers

Abstract

The mortality gap between the United States and other high-income nations substantially expanded during the first two decades of the 21st century. International comparisons of Covid-19 mortality suggest this gap might have grown during the Covid-19 pandemic. Applying population-weighted average mortality rates of the five largest West European countries to the US population reveals that this mortality gap increased the number of US deaths by 34.8% in 2021, causing 892,491 “excess deaths” that year. Controlling for population size, the annual number of excess deaths has nearly doubled between 2019 and 2021 (+84.9%). Diverging trends in Covid-19 mortality contributed to this increase in excess deaths, especially towards the end of 2021 as US vaccination rates plateaued at lower levels than in European countries. In 2021, the number of excess deaths involving Covid-19 in the United States reached 223,266 deaths, representing 25.0% of all excess deaths that year. However, 45.5% of the population-standardized increase in excess deaths between 2019 and 2021 is due to other causes of deaths. While the contribution of Covid-19 to excess mortality 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%).

Missing Americans: Early death in the United States—1933–2021

“…“Missing Americans” offers an alternative, easily interpretable metric: the number of US deaths that would have been averted if the United States had the ASMRs of its peers. Our analysis builds on our ( 11 ) and others' ( 7 , 8 ) previous analyses documenting excess US deaths prior to COVID-19 and during the pandemic ( 21 ), as well as research on the racial distribution of excess deaths before the pandemic ( 11 , 33 ) and in pandemic-associated mortality ( 24 , 25 , 34 , 35 ).…”

“…Our comparison set makes comprehensive use of available data on peer countries, following recent work on mortality trends ( 1 , 17 , 29 ). However, we also present missing Americans estimates using two alternate comparison groups that have been used in international mortality comparisons: the other Group of Seven (G7) countries—Canada, France, Germany, Italy, Japan, and the United Kingdom—used in prior work by members of this study team ( 11 ) and the five largest Western European countries—France, Germany, Italy, Spain, and the United Kingdom—used by Preston and Vierboom ( 8 ) and Heuveline ( 21 ).…”

“…We extend prior analyses of excess US deaths in three directions ( 7 , 8 , 11 , 21 ). First, we estimate long-term historical trends in excess US deaths, starting in 1933 (when the US mortality series begins).…”

American College of Lifestyle Medicine Expert Consensus Statement: Lifestyle Medicine for Optimal Outcomes in Primary Care

“…1,7 The US also leads in “excess” mortality; with avoidable deaths worsening three years after the COVID-19 pandemic began despite other countries showing lower mortality. 1,8,9…”

Faltering mortality improvements at young-middle ages in high-income English-speaking countries

“…7 The Covid-19 pandemic has had a further dramatic impact on longevity globally including in HICs. 8,9 Much of the recent discourse on life expectancy has concentrated on the growing challenge of mortality in old age in rapidly ageing societies. For example, in a set of 18 OECD countries, a comparative study showed a substantial although transient decline in life expectancy in the majority of HICs in 2014-15 which was likely related to a particularly severe influenza season 10 that was predominantly driven by trends at older age.…”