Study estimates 522,000 excess US deaths during pandemic

An analysis of US mortality data shows all-cause mortality rose 23% in 2020, researchers reported today in JAMA.

To assess excess deaths during the pandemic, researchers from Virginia Commonwealth University School of Medicine examined provisional data from the National Center for Health Statistics and the US Census on observed deaths from COVID-19 and non-COVID causes in 49 states and the District of Columbia from Mar 1, 2020, through Jan 2, 2021. They then compared the numbers to a model that used US mortality data from 2014 through 2019 to predict expected deaths in 2020. They also looked at regional death patterns.

The analysis found that the US experienced 2,801,439 deaths from Mar 1, 2020 through Jan 2, 2021, 22.9% more than expected, representing 522,368 excess deaths. The excess death rate was higher among Black populations (208.4 deaths per 100,000) than among White or Hispanic populations (157.0 and 139.8 deaths per 100,000, respectively). The percentage of excess deaths among Black individuals exceeded their share of the US population (12.5%).

Excess deaths surged in four patterns, with New England and the Northeast seeing a surge in the spring, the Southeast and Southwest in the summer and early winter, the Plains, Rocky Mountain, and far West regions primarily in early winter, and the Great Lakes, bimodally, in the spring and early winter.

Deaths attributed to COVID-19 accounted for 72.4% of excess deaths. The analysis also revealed an increase in weekly deaths from non-COVID causes, including heart disease, Alzheimer disease/dementia, and diabetes. Those increases occurred mainly during COVID-19 surges, and the study authors suggest they could reflect either immediate or delayed mortality from undocumented COVID-19 infection or secondary impacts of the pandemic, such as delayed care or behavioral health crises.

In an accompanying editorial, Alan Garber, MD, PhD, of Harvard University says the analysis highlights not only the toll of the COVID-19 pandemic but also what happens when nations fail to anticipate and plan for infectious disease outbreaks.

“Despite the scientific, medical, and public health progress of recent decades, the loss of life attributable to the COVID-19 pandemic exceeds the mortality of major wars,” he writes. “No nation should squander this opportunity to do what it takes to prepare for the next one.”
Apr 2 JAMA research letter
Apr 2 JAMA editorial

Home oxygen care linked with low COVID-19 hospital readmission

Hospitalized patients with COVID-19 pneumonia who were discharged with home oxygen equipment after being clinically stable had an 8.5% readmission rate, which led to a 1.3% rate of in-hospital deaths, according to a study yesterday in JAMA Network Open. None died in ambulatory care.

The researchers followed up with 621 clinically stable adults discharged with home oxygen from Mar 20 to Aug 19, 2020, for a median of 26 days. All patients had been hospitalized in California for COVID-19 pneumonia and had received a median of 2.0 liters of oxygen per minute while in the hospital. Upon discharge, they received home oxygen equipment, educational resources, and at least one follow-up phone call within 12 to 18 hours.

Thirty-day readmission rate was 8.5%, well below the US all-cause rate for patients with Medicaid (13.7%), which insured 76% of study participants, and consistent with those privately insured (8.6%). The 1.3% mortality rate was comparable to overall in-hospital mortality for COVID-19 pneumonia patients who did not have a home oxygen regimen.

Median patient age was 51 years, most (65.1%) were male, and 84% spoke Spanish. The most commonly reported preexisting health conditions were diabetes (37.8%), high blood pressure (34.1%), and obesity (18.4%).

The authors conclude that home oxygen “may be considered part of a strategy to ensure right care, right place, and right time for patients with COVID-19 pneumonia, and to preserve acute care access during the pandemic.”
Apr 1 JAMA Netw Open study