By Carol A. Kemper, MD, FACP
Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley Medical Center
SOURCE: Rossen LM, Branum AM, Ahmad FB, et al. Excess deaths associated with COVID-19, by age and race and ethnicity — United States, January 26-October 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1522-1527.
Skeptics have expressed concern that mortality from COVID-19 infection is overestimated or, worse, manipulated. Compared with previous years, it is clear from national data that more people in the United States have died this year than anticipated — and not just older patients, but younger people have been affected disproportionately.
The measurement of excess deaths, as defined by the number of persons dying from all causes in excess of that anticipated for a given place and time, is useful when questions have been raised about the attribution of death to a given cause — or, in this case, the overall effect of COVID-19 on death rates in the United States. Some of this could be caused by unrecognized COVID-19 infection or an indirect effect of the pandemic on the healthcare system and the ability to receive care for other reasons.
Mortality data from the CDC National Vital Statistics System was used to examine differences in the number of deaths as defined by age and ethnicity, compared with the same weeks from 2015-2019. The percentage of excess deaths from all causes, as well as that from all deaths excluding those attributed to COVID-19, were estimated. (Expected numbers of deaths were estimated using over-dispersed Poisson regression models, accounting for seasonal trends, and also weighted for possible incomplete reporting in more recent weeks).
Compared with death data for the same weeks from prior years, nearly 300,000 excess deaths occurred in the United States between the weeks ending Jan. 26 through Oct. 3, 2020. Two-thirds were attributed to COVID-19 (n = 198,081). The remaining deaths were largely attributed to vascular events, respiratory disease, and dementia/Alzheimer’s.
Excess deaths reached their highest points during the weeks ending April 11 and Aug. 8, 2020. As imagined, the lowest number of excess deaths occurred in the youngest age group (< 25 years), and the highest number of excess deaths occurred in the oldest age group (75-84 years). However, the greatest percentage change in unanticipated deaths was experienced in those 25-44 years of age (26.5%).
The percentage of excess deaths in 2020 compared with averages for the previous five years for other age groups was: 14.4% for ages 45-64 years, 24.1% for ages 65-74 years, 21.5% for ages 75-84 years, and 14.7% for ages > 85 years. The greatest percentage difference in excess deaths occurred in Latinos (53.6%), followed by Asians (36.6%), Blacks (34.6%), and American Indian/Native Americans (28.9%). In contrast, the percentage of excess deaths in whites was 11.9%. This finding is consistent with reported disparities in COVID-19 deaths in Latinos and other minorities.