April 13, 2021 | Press Release

COVID-19 Is Not the Only Cause of Excess Deaths in the U.S.

Disclaimer (added on February, 15, 2022): This paper examines two different kinds of elevated mortality that are called excess mortality. In the first metric, the researchers compared the pre-pandemic U.S. to five similar European countries. They found that if the U.S. had the much-lower mortality rates of these European countries, more than 400,000 deaths in the U.S. would be avoided each year.

The researchers then compared this number to the staggering number of deaths from COVID-19 that occurred in 2020 alone. In 2020, more than 375,000 people in the U.S. died from COVID-19. The combination of a global pandemic and the shortcoming of U.S. mortality that already existed before the pandemic began highlights the grave forces facing American mortality today.

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The population in the United States suffers from a mortality disadvantage. By comparing death rates in the U.S. with those of the five biggest European countries, demographer Yana Vierboom and a colleague found excess death numbers to be greater than the number of deaths attributed to COVID-19 in 2020.

Within their research, the two demographers showed that relative to ist European peers, age-specific death rates in the United States for people under the age of 85 have been deteriorating sharply since 2000. By 2017, the U.S. was already suffering more excess deaths and more life years lost each year than those associated with the COVID-19 pandemic in 2020.

The U.S. Centers for Disease Control reported that 376,504 deaths ascribed to COVID-19 had occurred in the U.S. in calendar year 2020. That figure is similar to, but below, the estimated total number of excess deaths of 401,000 in the U.S. in 2017.

“We do not want to diminish the tremendous losses due to COVID-19 in the U.S. and elsewhere — it’s just a helpful tool to put the U.S. mortality disadvantage into perspective,” says Yana Vierboom, Research Scientist at the Max Planck Institute for Demographic Research (MPIDR) in Rostock, Germany.

Country size as a valid selection criterion

Vierboom and her colleague Samuel Preston from the University of Pennsylvania used data from the Human Mortality Database to create three indexes designed to make age-specific comparisons of U.S. and European mortality between 2000 and 2017. Their paper was published in the journal Proceedings of the National Academies of Science.

The demographers chose the five largest European countries, Germany, England & Wales, France, Italy, and Spain for the comparison. Combined, the population size of these five countries is similar to that of the U.S. “We used size as a selection criterion. In small populations, there are many interdependent factors affecting mortality, like climate, diet, social history, and health care. Larger and more diverse populations are more similar in that sense, says Yana Vierboom.

Results underscore persistent daily health hazards

The mortality comparison between the U.S. and those five European countries was even more striking when years of life lost was the measurement used. A total of 4.41 million years of life were lost to COVID-19 in 2020. That is only a third of the 13.02 million life years lost to excess mortality in the United States in 2017.

The reason that the comparison was so much sharper for years of life lost than for excess deaths is that people who died from COVID-19 in 2020 were much older, on average, than those people identified as excess deaths in 2017.

“Our results underscore the routine and persistent daily health hazards that Americans face. Identifying and remediating the factors that contribute to this massive loss of life should be a national priority,” says Yana Vierboom.

Original publication

Preston, S.H. Vierboom, Y.C.: Excess Mortality in the United States in the Twenty-First Century. PNAS Brief Report (2021) DOI: 10.1073/pnas.2024850118

Authors and Affiliations

Samuel Preston, University of Pennsylvania 

Yana Vierboom, Max Planck Institute for Demographic Research, Rostock


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Author of the Paper

Research Scientist and Training Chair – Department Myrskylä

Yana Catherine Vierboom


The Max Planck Institute for Demographic Research (MPIDR) in Rostock is one of the leading demographic research centers in the world. It's part of the Max Planck Society, the internationally renowned German research society.