Department of Epidemiology of Microbial Diseases and the Public Health Modeling Unit, Yale School of Public Health, New Haven, Connecticut.
Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
JAMA Intern Med. 2020 Oct 1;180(10):1336-1344. doi: 10.1001/jamainternmed.2020.3391.
Efforts to track the severity and public health impact of coronavirus disease 2019 (COVID-19) in the United States have been hampered by state-level differences in diagnostic test availability, differing strategies for prioritization of individuals for testing, and delays between testing and reporting. Evaluating unexplained increases in deaths due to all causes or attributed to nonspecific outcomes, such as pneumonia and influenza, can provide a more complete picture of the burden of COVID-19.
To estimate the burden of all deaths related to COVID-19 in the United States from March to May 2020.
DESIGN, SETTING, AND POPULATION: This observational study evaluated the numbers of US deaths from any cause and deaths from pneumonia, influenza, and/or COVID-19 from March 1 through May 30, 2020, using public data of the entire US population from the National Center for Health Statistics (NCHS). These numbers were compared with those from the same period of previous years. All data analyzed were accessed on June 12, 2020.
Increases in weekly deaths due to any cause or deaths due to pneumonia/influenza/COVID-19 above a baseline, which was adjusted for time of year, influenza activity, and reporting delays. These estimates were compared with reported deaths attributed to COVID-19 and with testing data.
There were approximately 781 000 total deaths in the United States from March 1 to May 30, 2020, representing 122 300 (95% prediction interval, 116 800-127 000) more deaths than would typically be expected at that time of year. There were 95 235 reported deaths officially attributed to COVID-19 from March 1 to May 30, 2020. The number of excess all-cause deaths was 28% higher than the official tally of COVID-19-reported deaths during that period. In several states, these deaths occurred before increases in the availability of COVID-19 diagnostic tests and were not counted in official COVID-19 death records. There was substantial variability between states in the difference between official COVID-19 deaths and the estimated burden of excess deaths.
Excess deaths provide an estimate of the full COVID-19 burden and indicate that official tallies likely undercount deaths due to the virus. The mortality burden and the completeness of the tallies vary markedly between states.
由于美国各州在诊断检测的可及性、个体检测优先级的不同策略以及检测和报告之间的延迟方面存在差异，因此追踪 2019 年冠状病毒病（COVID-19）的严重程度和公共卫生影响的工作受到了阻碍。评估所有原因导致的不明原因死亡人数或归因于非特异性结果（如肺炎和流感）的增加，可以更全面地了解 COVID-19 的负担。
估计 2020 年 3 月至 5 月美国与 COVID-19 相关的所有死亡人数。
设计、地点和人群：本观察性研究使用国家卫生统计中心（NCHS）的整个美国人口的公共数据，评估了 2020 年 3 月 1 日至 5 月 30 日期间任何原因导致的美国死亡人数以及肺炎、流感和/或 COVID-19 导致的死亡人数。将这些数字与前几年同期的数据进行了比较。所有分析的数据均于 2020 年 6 月 12 日获取。
与季节性、流感活动和报告延迟相适应的基础上，每周因任何原因导致的死亡人数或因肺炎/流感/COVID-19 导致的死亡人数的增加。将这些估计值与报告的 COVID-19 死亡人数和检测数据进行了比较。
2020 年 3 月 1 日至 5 月 30 日期间，美国共有约 78.1 万人死亡，比该季节通常预期的死亡人数多出约 122300 人（95%预测区间为 116800-127000）。2020 年 3 月 1 日至 5 月 30 日期间，官方报告有 95235 人死于 COVID-19。全因超额死亡人数比同期官方报告的 COVID-19 死亡人数高出 28%。在几个州，这些死亡发生在 COVID-19 诊断检测可用性增加之前，并未计入官方 COVID-19 死亡记录。各州之间官方 COVID-19 死亡人数与估计的超额死亡人数之间存在很大差异。
超额死亡人数提供了 COVID-19 总负担的估计数，并表明官方统计数据可能低估了与该病毒相关的死亡人数。死亡率负担和统计数据的完整性在各州之间差异显著。
