Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020
Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020
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DOI：
10.1001/jamainternmed.2020.3391
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发表时间：
2020-10-01
影响因子：
39
通讯作者：
Viboud, Cecile
中科院分区：
文献类型：
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作者：
Weinberger, Daniel M.;Chen, Jenny;Viboud, Cecile
追踪美国2019冠状病毒病（COVID-19）的严重程度和公共卫生影响的努力受到各州诊断测试可用性差异、个人测试优先级不同策略以及测试和报告之间延迟的阻碍。评估由于所有原因或归因于非特异性结果（如肺炎和流感）的死亡原因不明的增加，可以更全面地了解COVID-19的负担。目的估计2020年3月至5月美国所有与COVID-19相关的死亡的负担。设计，设置，这项观察性研究评估了2020年3月1日至5月30日期间美国因任何原因死亡以及因肺炎、流感和/或COVID-19死亡的人数，使用来自国家卫生统计中心（NCHS）的整个美国人口的公共数据。这些数字与前几年同期的数字进行了比较。所有分析的数据均于2020年6月12日获得。主要结果和指标每周因任何原因死亡或因肺炎/流感/COVID-19死亡的增加高于基线，该基线根据一年中的时间，流感活动和报告延迟进行了调整。结果2020年3月1日至5月30日，美国共有约781 000人死亡，比每年同期的通常预期死亡人数多122 300人（95%预测区间，116 800-127 000人）。2020年3月1日至5月30日，官方报告的95235例死亡归因于COVID-19。在此期间，全因死亡人数比官方报告的COVID-19死亡人数高出28%。在几个州，这些死亡发生在COVID-19诊断检测可用性增加之前，未计入官方COVID-19死亡记录。结论和相关性超额死亡人数提供了对COVID-19全部负担的估计，并表明官方统计可能低估了因病毒造成的死亡人数。死亡率负担和统计的完整性在各州之间差异很大。
IMPORTANCE Efforts to track the severity and public health impact of coronavirus disease 2019 (COVID-19) in the United States have been hampered by state-level differences in diagnostic test availability, differing strategies for prioritization of individuals for testing, and delays between testing and reporting. Evaluating unexplained increases in deaths due to all causes or attributed to nonspecific outcomes, such as pneumonia and influenza, can provide a more complete picture of the burden of COVID-19.OBJECTIVE To estimate the burden of all deaths related to COVID-19 in the United States from March to May 2020.DESIGN, SETTING, AND POPULATION This observational study evaluated the numbers of US deaths from any cause and deaths from pneumonia, influenza, and/or COVID-19 from March 1 through May 30, 2020, using public data of the entire US population from the National Center for Health Statistics (NCHS). These numbers were compared with those from the same period of previous years. All data analyzed were accessed on June 12, 2020.MAIN OUTCOMES AND MEASURES Increases in weekly deaths due to any cause or deaths due to pneumonia/influenza/COVID-19 above a baseline, which was adjusted for time of year, influenza activity, and reporting delays. These estimates were compared with reported deaths attributed to COVID-19 and with testing data.RESULTS There were approximately 781 000 total deaths in the United States from March 1 to May 30, 2020, representing 122 300 (95% prediction interval, 116 800-127 000) more deaths than would typically be expected at that time of year. There were 95 235 reported deaths officially attributed to COVID-19 from March 1 toMay 30, 2020. The number of excess all-cause deaths was 28% higher than the official tally of COVID-19-reported deaths during that period. In several states, these deaths occurred before increases in the availability of COVID-19 diagnostic tests and were not counted in official COVID-19 death records. There was substantial variability between states in the difference between official COVID-19 deaths and the estimated burden of excess deaths.CONCLUSIONS AND RELEVANCE Excess deaths provide an estimate of the full COVID-19 burden and indicate that official tallies likely undercount deaths due to the virus. The mortality burden and the completeness of the tallies vary markedly between states.