The US Midlife Mortality Crisis Continues: Excess Cause-Specific Mortality During 2020

Am J Epidemiol. 2022 Sep 28;191(10):1677-1686. doi: 10.1093/aje/kwac055.


Whether monthly excess mortality in the United States during 2020 varied by age and cause of death is investigated in this analysis. Based on national-level death counts and population estimates for 1999-2020, sex-specific negative binomial regression models were used to estimate monthly cause-specific excess mortality by age group during 2020. Among men, 71% non-COVID excess deaths occurred at working ages (25-64 years), but those ages accounted for only 36% of non-COVID excess deaths among women. Many excess deaths resulted from external causes (particularly among men), heart disease, diabetes, Alzheimer disease (particularly among women), and cerebrovascular disease. For men, the largest share of non-COVID excess deaths resulted from external causes, nearly 80% of which occurred at working ages. Although incorrectly classified COVID-19 deaths may explain some excess non-COVID mortality, misclassification is unlikely to explain the increase in external causes of death. Auxiliary analyses suggested that drug-related deaths may be driving the increase in external mortality, but drug overdoses were already increasing for a full year before the pandemic. The oldest Americans bore the brunt of COVID-19 deaths, but working-age Americans, particularly men, suffered substantial numbers of excess non-COVID deaths, most commonly from external causes and heart disease.

Keywords: COVID-19; United States; age variation; cause of death; excess mortality.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • COVID-19*
  • Cause of Death
  • Female
  • Heart Diseases*
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Mortality
  • Pandemics
  • United States / epidemiology