Importance Previous studies have shown the pre-pandemic emergence of a gap in mortality between the United States and other high-income nations. This gap was estimated to account for nearly one in seven US deaths in 2017. Objective The number and proportion of US deaths that can be attributed to this gap is expected to have grown during the pandemic. This study aims at quantifying this growth at the end of 2021. Design This cross-sectional study uses publicly available 2017 to 2021 data on deaths from all causes and 2020-2021 Covid-19 death counts in the United States and five European countries. Number of deaths are combined with publicly available estimates of population size by sex and age group in these European countries to produce sex- and age-specific mortality rates. These rates are averaged and applied to the US population by sex and age-group to compare the resulting and actual US death counts. Setting The United States and the five most populous countries in Western Europe. Participants All deceased individuals in these countries are included in the death counts. This study does not use individual records. Intervention None. Main Outcome and Measure Total number of US deaths and their counterfactuals when substituting average sex- and age-specific mortality rates for the European countries to those that prevailed in the United States. Results The counterfactuals reveal 711,109 to 747,783 excess deaths in the United States in 2021, amounting to 20.8% to 21.7% of all US deaths that year (3,426,249). Excess deaths increased by 320,436 to 331,477 between 2017 and 2021, 80.0% to 82.7% more than the 2017 estimate. A decomposition of the lower figure showed that population change contributed little to the 2017-2021 increase in excess deaths (33,545 additional deaths). Covid-19 mortality alone continue contributed 230,672 excess deaths in 2021, more than 2020, whereas other causes of deaths contributed 56,219 more excess deaths in 2021 than in 2017. Discussion The proportion of US deaths that would be avoided if the United States could achieve the mortality of its West European counterparts surged to more than one in five during the pandemic. The large and still growing contribution of Covid-19 to excess mortality in the United States is consistent with vaccination rates plateauing at lower levels than in European countries. The overall increase in mortality from other causes during the pandemic increasingly separates the United States from West European countries as well.
The dramatic surge of excess mortality in the United States between 2017 and 2021