Excess US Deaths Before, During and After the COVID-19 Pandemic

Mortality rates decreased more slowly in the US than in other high-income countries (HICs) between 1980 and 2019, resulting in growing numbers of excess US deaths compared with other HICs. 

A new journal article published in JAMA Health Forum by Jacob Bor and coauthors assesses trends in excess US deaths before (1980-2019), during (2020-2022) and after (2023) the acute phase of the COVID-19 pandemic. They estimate that, between 1980 and 2023, the total number of excess US deaths reached 14.7 million.

Key findings:

• An estimated 14,735,913 excess deaths occurred in the US in the 1980-2023 period compared with other HICs.
• US mortality rose rapidly in 2020 and 2021 during the pandemic, then declined in 2022 and 2023. The pandemic-era mortality surge was less pronounced in other HICs.
• Relative differences between the US and other HICs widened before and during the pandemic, particularly among younger adults, before contracting in 2022 and 2023. 
• In 2023, mortality among US adults aged 25-44 years was 2.6 times higher than in other HICs.
• Excess deaths attributable to the US mortality disadvantage peaked at 1 ,008 ,369 in 2020 and 1, 098 ,808 in 2021, then declined to 820, 396 in 2022 and 705, 331 in 2023.
  • These numbers followed four decades of rising excess deaths, reaching 631, 247 in 2019.
• In 2023, excess US deaths accounted for 22.9 percent of all deaths and 46.0 percent of deaths among US residents younger than 65 years.

Ultimately, these deaths highlight the continued consequences of US health system inadequacies, economic inequality, and social and political determinants of health.

An earlier version of this analysis was published as a working paper in medRxiv in July 2022.