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COVID-19 and Excess All-Cause Mortality in the US and 18 Comparison Countries

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Article Information

Corresponding Author: Ezekiel J. Emanuel, MD, PhD, Perelman School of Medicine, University of Pennsylvania, Medical Ethics and Health Policy, 423 Guardian Dr, Blockley Hall, Ste 1412, Philadelphia, PA 19104 (MEHPchair@upenn.edu).

Accepted for Publication: October 2, 2020.

Published Online: October 12, 2020. doi:10.1001/jama.2020.20717

Author Contributions: Ms Bilinski had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design; acquisition, analysis, or interpretation of data; and drafting of the manuscript: Both authors.

Critical revision of the manuscript for important intellectual content: Emanuel.

Statistical analysis: Bilinski.

Obtained funding: Emanuel.

Administrative, technical, or material support: Emanuel.

Supervision: Emanuel.

Conflict of Interest Disclosures: Dr Emanuel reported receiving personal fees and nonfinancial support from Blue Cross Blue Shield Minnesota, Bergen University, United Health Group, Futures Without Violence, Children’s Hospital of Philadelphia, Washington State Hospital Association, the Association of Academic Health Centers, Blue Cross Blue Shield of Massachusetts, Lumeris, Roivant Sciences, Medical Specialties Distributors, Vizient University Health System Consortium, the Center for Neurodegenerative Disease Research, Genentech Oncology, the Council of Insurance Agents and Brokers, America’s Health Insurance Plans, the Montefiore Physician Leadership Academy, Medical Home Network, the Healthcare Financial Management Association, Ecumenical Center–UT Health, the American Academy of Optometry, the Associação Nacional de Hospitais Privados, the National Alliance of Healthcare Purchaser Coalitions, Optum Labs, the Massachusetts Association of Health Plans, the District of Columbia Hospital Association, Washington University, Optum, Brown University, McKay Lab, the American Society for Surgery of the Hand, the Association of American Medical Colleges, America’s Essential Hospitals, Johns Hopkins University, the National Resident Matching Program, Shore Memorial Health System, Tulane University, Oregon Health and Science University, Blue Cross Blue Shield, and the Center for Global Development, as well as nonfinancial support from the Delaware Healthcare Spending Benchmark Summit, Geisinger Health System, RAND Corporation, Goldman Sachs, The Atlantic, Village MD, and Oncology Analytics. Dr Emanuel is also a venture partner at Oak HC/FT, and a partner at Embedded Healthcare LLC and COVID-19 Recovery Consulting. Ms Bilinski reported no disclosures.

Funding/Support: This research was partially funded by the Colton Foundation.

Role of the Funder/Sponsor: The Colton Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank David Cutler, PhD, of the Harvard University Department of Economics, for helpful feedback, for which he received no compensation.

Additional Information: Data and code are publicly available on GitHub.

References
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COVID-19 data. European Centre for Disease Prevention and Control. Accessed September 25, 2020. https://www.ecdc.europa.eu/en/covid-19/data
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Lyu  W , Wehby  GL .  Shelter-in-place orders reduced COVID-19 Mortality and reduced the rate of growth in hospitalizations: study examine effects of shelter-in-places orders on daily growth rates of COVID-19 deaths and hospitalizations using event study models.   Health Aff (Millwood). 2020;39(9):1615-1623. doi:10.1377/hlthaff.2020.00719PubMedGoogle ScholarCrossref
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Verity  R , Okell  LC , Dorigatti  I ,  et al.  Estimates of the severity of coronavirus disease 2019: a model-based analysis.   Lancet Infect Dis. 2020;20(6):669-677. doi:10.1016/S1473-3099(20)30243-7PubMedGoogle ScholarCrossref
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Maani  N , Galea  S .  COVID-19 and underinvestment in the public health infrastructure of the United States.   Milbank Q. 2020;98(2):250-259. doi:10.1111/1468-0009.12463PubMedGoogle ScholarCrossref
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Chaudhry  R , Dranitsaris  G , Mubashir  T , Bartoszko  J , Riazi  S .  A country level analysis measuring the impact of government actions, country preparedness and socioeconomic factors on COVID-19 mortality and related health outcomes.   EClinicalMedicine. 2020;25:100464. doi:10.1016/j.eclinm.2020.100464PubMedGoogle Scholar
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