Am J Epidemiol. 2022 Sep 28;191(10):1677-1686. doi: 10.1093/aje/kwac055.
Whether monthly excess mortality in the United States during 2020 varied by age and cause of death is investigated in this analysis. Based on national-level death counts and population estimates for 1999-2020, sex-specific negative binomial regression models were used to estimate monthly cause-specific excess mortality by age group during 2020. Among men, 71% non-COVID excess deaths occurred at working ages (25-64 years), but those ages accounted for only 36% of non-COVID excess deaths among women. Many excess deaths resulted from external causes (particularly among men), heart disease, diabetes, Alzheimer disease (particularly among women), and cerebrovascular disease. For men, the largest share of non-COVID excess deaths resulted from external causes, nearly 80% of which occurred at working ages. Although incorrectly classified COVID-19 deaths may explain some excess non-COVID mortality, misclassification is unlikely to explain the increase in external causes of death. Auxiliary analyses suggested that drug-related deaths may be driving the increase in external mortality, but drug overdoses were already increasing for a full year before the pandemic. The oldest Americans bore the brunt of COVID-19 deaths, but working-age Americans, particularly men, suffered substantial numbers of excess non-COVID deaths, most commonly from external causes and heart disease.
本分析旨在调查 2020 年美国是否存在与年龄和死因相关的月度超额死亡率。基于 1999-2020 年的国家级死亡人数和人口估计数，采用特定性别负二项回归模型，估计了 2020 年各年龄段与死因相关的月度超额死亡率。在男性中，71%的非 COVID 超额死亡发生在工作年龄段（25-64 岁），但这些年龄段仅占女性非 COVID 超额死亡的 36%。许多超额死亡归因于外部原因（尤其是男性）、心脏病、糖尿病、阿尔茨海默病（尤其是女性）和脑血管病。对于男性，非 COVID 超额死亡的最大部分归因于外部原因，其中近 80%发生在工作年龄段。尽管 COVID-19 死亡的错误分类可能解释了一些非 COVID 超额死亡率，但错误分类不太可能解释死亡原因中外部原因的增加。辅助分析表明，与药物相关的死亡可能是导致外部死亡率增加的原因，但在大流行前整整一年，药物过量死亡就已经在增加。最年长的美国人首当其冲地受到 COVID-19 死亡的影响，但处于工作年龄段的美国人，尤其是男性，遭受了大量非 COVID 超额死亡，最常见的死因是外部原因和心脏病。
