COVID widened excess death gap between US and European countries

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The United States has had substantially higher death rates than similar high-income countries in Europe in all but the oldest age groups, but the gap widened even more during the COVID-19 pandemic, a new study revealed today.

Earlier studies had documented a widening mortality gap between the United States and five European countries between 2000 and 2017. The five countries include England and Wales, France, Germany, Italy, and Spain. A comparison of the latest excess death trends between the two regions from 2017 through 2021 appears today in PLoS One.

Multiple causes, deaths in younger adults influenced US trends

Covering a period that includes the first years of the COVID-19 pandemic, Patrick Heuveline, PhD, professor of sociology at the University of California, Los Angeles, calculated excess death rates for the United States and the same five countries, finding that that gap widened between 2017 and 2021 and that COVID-19 contributed to the increase.

Between 2019 and 2021, excess deaths in the United States nearly doubled, but 45% of the rise was from causes other than COVID-19. Looking just at 2021, 25% of all excess deaths were linked to COVID-19, which accounted for 223,266 of 892,491 excess deaths from any cause.

Heuveline said the increased deaths from other causes during the study period could reflect a higher degree of COVID-19 deaths being attributed to other causes. Also, rates of unintentional injuries in the United States, such as those involving opioids and alcohol, are also rising.

And though the contribution of COVID-19 deaths should tilt toward older age groups, in the United States, deaths in adults ages 15 to 64 continue to make up slightly more than half of excess deaths in recent years.

Vaccination gaps, health disparities among possible reasons

In a PLOS press release, Heuveline said more research is needed to tease out how the pandemic widened the excess mortality gap between the US and some of its European peers. He said, for example, that studies could examine if vaccination rates or social conditions that put a disproportionate burden on minority populations may have played a role.

"The mortality gap widened during the pandemic, but not just due to the US handling of the crisis mortality from Covid-19," he said. "The chronic toll of excess deaths due to causes other than Covid-19 continued to increase as well, further demonstrating the US health policy failure to integrate the social, psychological and economic dimensions of health, from a weak social security net and lack of health care access for all to poor health behaviors."

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