Zalla Lauren C, Lesko Catherine R
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, United States.
Am J Epidemiol. 2025 Mar 4;194(3):779-790. doi: 10.1093/aje/kwae166.
To estimate the burden of excess mortality from 17 underlying causes of death between March and December 2020 in the United States and to compare trends in excess deaths from non-COVID causes vs from COVID-19. Using time-series models, we estimated monthly counts of all-cause and cause-specific excess deaths. We stratified by geographic region and compared temporal trends in excess deaths from non-COVID causes to trends in deaths attributed to COVID-19. Of approximately 500 000 excess deaths, 70% were attributed to COVID-19. We observed increases in several underlying causes of death, ranging from a 3% increase in kidney disease deaths to a 24% increase in homicides, as well as decreases in deaths from cancer (-0.3%), influenza and pneumonia (-2%), chronic lower respiratory disease (-3%), and suicide (-7%). Trends in excess deaths from cardiovascular disease, diabetes, and Alzheimer disease closely mirrored trends in deaths from COVID-19. Trends in excess liver disease, homicide, suicide, and motor vehicle accident deaths were negatively correlated with trends in deaths from COVID-19. There was wide regional variation in excess death rates for some causes of death, including a disproportionate increase in homicide and motor vehicle accident deaths in the Great Lakes and a sustained reduction in cancer deaths in the Mideast and New England. Increases in cardiovascular disease, diabetes, and Alzheimer disease deaths from March to December 2020 likely reflect health care system disruptions or acute complications of COVID-19. Excess deaths from homicide and liver disease are more likely to reflect social and economic effects of the emerging pandemic or other separate causes.
为估算2020年3月至12月期间美国17种潜在死因导致的超额死亡负担，并比较非新冠病因与新冠病毒病所致超额死亡的趋势。我们使用时间序列模型估算全因及特定病因的每月超额死亡数。我们按地理区域进行分层，并比较非新冠病因所致超额死亡的时间趋势与归因于新冠病毒病的死亡趋势。在约50万例超额死亡中，70%归因于新冠病毒病。我们观察到几种潜在死因有所增加，从肾病死亡增加3%到凶杀案死亡增加24%不等，同时癌症（-0.3%）、流感和肺炎（-2%）、慢性下呼吸道疾病（-3%）及自杀（-7%）死亡有所减少。心血管疾病、糖尿病和阿尔茨海默病的超额死亡趋势与新冠病毒病死亡趋势密切相关。肝病、凶杀案、自杀和机动车事故死亡的超额死亡趋势与新冠病毒病死亡趋势呈负相关。某些死因的超额死亡率存在广泛的地区差异，包括五大湖地区凶杀案和机动车事故死亡的不成比例增加，以及中东和新英格兰地区癌症死亡的持续减少。2020年3月至12月心血管疾病、糖尿病和阿尔茨海默病死亡的增加可能反映了医疗保健系统中断或新冠病毒病的急性并发症。凶杀案和肝病导致的超额死亡更可能反映新出现的大流行的社会和经济影响或其他单独原因。
