Am J Epidemiol. 2023 Nov 10;192(12):1949-1959. doi: 10.1093/aje/kwad127.
Understanding consequences of the COVID-19 pandemic requires information on the excess mortality resulting from it. Multiple studies have examined excess deaths during the pandemic's initial stages, but how these have changed over time is unclear. National- and state-level death counts and population data from 2009 to 2022 were used in this analysis to evaluate excess fatalities from March 2020 to February 2021 and March 2021 to February 2022, with deaths from earlier years used to project baseline counts. The outcomes were total, group-specific, cause-specific, and age-by-cause excess fatalities, and numbers and percentages directly involving COVID-19. Excess deaths declined from 655,735 (95% confidence interval: 619,028, 691,980) during the first pandemic year to 586,505 (95% confidence interval: 532,823, 639,205) in the second. The reductions were particularly large for Hispanics, Blacks, Asians, seniors, and residents of states with high vaccination rates. Excess deaths increased from the first to second year for persons younger than 65 years and in low-vaccination states. Excess mortality from some diseases declined, but those from alcohol, drug, vehicle, and homicide causes likely increased between the first and second pandemic year, especially for prime-age and younger individuals. The share of excess fatalities involving COVID-19 decreased modestly over time, with little change in its role as an underlying versus contributing cause of death.
了解 COVID-19 大流行的后果需要了解其导致的超额死亡人数。多项研究已经检查了大流行初期的超额死亡人数，但这些数字随时间的变化情况尚不清楚。本分析使用了 2009 年至 2022 年的国家和州级死亡人数和人口数据，以评估 2020 年 3 月至 2021 年 2 月和 2021 年 3 月至 2022 年 2 月的超额死亡人数，使用前几年的死亡人数来预测基线人数。结果包括总超额死亡人数、特定群体的超额死亡人数、特定原因的超额死亡人数以及按年龄和原因的超额死亡人数，以及直接涉及 COVID-19 的死亡人数和百分比。与第一年相比，第二年的超额死亡人数从 655735 人（95%置信区间：619028 人，691980 人）下降到 586505 人（95%置信区间：532823 人，639205 人）。降幅在西班牙裔、非裔、亚裔、老年人以及疫苗接种率高的州的居民中尤其明显。与第一年相比，65 岁以下人群和疫苗接种率低的州的超额死亡人数在第二年有所增加。一些疾病的超额死亡率有所下降，但酒精、药物、车辆和凶杀等原因的超额死亡率在第一年和第二年之间可能有所增加，尤其是在主要年龄组和更年轻的人群中。涉及 COVID-19 的超额死亡人数占比随时间略有下降，但其作为根本或促成死亡原因的作用变化不大。
