Patterns of Excess Mortality from Non-COVID Causes in the US, Mar-Dec 2020

Overview

Between March and December 2020, the US experienced approximately 500,000 excess deaths, with 70% attributed to COVID-19 and the remainder to various non-COVID causes. Notable increases were observed in deaths from homicide, cardiovascular disease, diabetes, and Alzheimer disease, while some causes like cancer and suicide saw decreases. Regional variations highlighted disproportionate rises in homicide and motor vehicle accident deaths in the Great Lakes region and sustained cancer death reductions in the Mideast and New England.

Background

In 2020, the US saw roughly 487,000 excess deaths beyond expected historical trends, with about 28% not attributed to COVID-19. Previous research identified increases in deaths from cardiovascular disease, diabetes, and homicide, potentially linked to healthcare disruptions, mental health challenges, and socioeconomic factors. Understanding spatiotemporal patterns of non-COVID excess mortality can clarify underlying biological and social mechanisms and improve public health responses. This study analyzed 17 specific causes of death across US regions to assess temporal and geographic trends during the pandemic.

Data Highlights

Key Findings

• Approximately 500,000 excess deaths occurred in the US from March to December 2020; 70% were attributed to COVID-19.
• Deaths from cardiovascular disease, diabetes, and Alzheimer disease increased and closely followed COVID-19 death trends, suggesting healthcare disruptions or COVID-19 complications.
• Homicide deaths increased by 24%, and liver disease deaths also rose, likely reflecting social and economic pandemic effects.
• Deaths from cancer, influenza and pneumonia, chronic lower respiratory disease, and suicide decreased during this period.
• Regional disparities were notable, with the Great Lakes region experiencing disproportionate increases in homicide and motor vehicle accident deaths, while the Mideast and New England saw sustained reductions in cancer deaths.
• Some causes of death, such as liver disease and homicide, showed temporal trends negatively correlated with COVID-19 deaths, indicating different underlying drivers.

Clinical Implications

Clinicians should be aware that excess mortality during the pandemic extended beyond COVID-19 infections, with increases in cardiovascular, metabolic, and neurodegenerative disease deaths potentially linked to healthcare access disruptions. The rise in homicide and liver disease deaths underscores the importance of addressing social determinants of health and mental health during public health crises. Regional variations suggest tailored interventions may be necessary to mitigate indirect pandemic effects on mortality.

Conclusion

The COVID-19 pandemic led to substantial excess mortality from both COVID-19 and non-COVID causes, with distinct temporal and geographic patterns. Understanding these patterns can inform targeted public health strategies to reduce indirect mortality during ongoing and future pandemics.

References

1. CDC 2020 -- Excess Deaths Associated with COVID-19
2. National Center for Health Statistics 2020 -- Mortality Data
3. Study Authors 2022 -- Patterns of Excess Mortality from Non-COVID Causes in the United States