Excess death gap widens between US and Europe

A new analysis shows that, compared to similarly high-income European countries, the U.S. continues to have substantially higher death rates at all but the oldest ages, resulting in more “excess deaths,” and this gap widened during the COVID-19 pandemic. Patrick Heuveline, of the University of California, Los Angeles (UCLA), presents these findings in the open-access journal PLOS ONE on March 29, 2023.

Calculating excess death rates can be useful for comparing mortality between different countries or sub-populations, as well as before and after the onset of a health crisis. Prior research has documented a substantial widening of the mortality gap between the U.S. and five high-income European countries between 2000 and 2017. Mounting evidence suggests that, compared to those countries, the U.S. has experienced even higher COVID-19 mortality during the pandemic.

Building on those earlier studies, Heuveline calculated excess death rates in the U.S. relative to the same five countries—England & Wales, France, Germany, Italy, and Spain—for 2017 through 2021. The calculations account for different population sizes between the countries.

Heuveline found that the number of excess deaths between the U.S. and the five European countries did indeed increase between 2017 and 2021, and that COVID-19 mortality contributed to this increase. Between 2019 and 2021, the annual number of excess deaths in the U.S. nearly doubled, however, 45% of this rise was due to causes other than COVID-19. In 2021, 25% of all excess deaths in the U.S. were attributed to COVID-19, representing 223,266 deaths out of 892,491 total excess deaths from any cause.

Further research will be needed to identify specific underlying reasons for how, exactly, the COVID-19 pandemic helped to drive the widening excess deaths gap between the U.S. and Europe. For instance, Heuveline suggests, such research could explore differences in vaccination rates or social conditions that place a disproportionate impact on minority populations.

Heuveline adds, “The mortality gap widened during the pandemic, but not just due to the U.S. handling of the crisis mortality from COVID-19. The chronic toll of excess deaths due to causes other than COVID-19 continued to increase as well, further demonstrating the U.S. health policy failure to integrate the social, psychological and economic dimensions of health, from a weak social security net and lack of health care access for all to poor health behaviors.”