Disease-specific Excess Mortality During the COVID-19 Pandemic

An Analysis of Weekly US Death Data for 2020

Dongshan Zhu, PhD; Akihiko Ozaki, PhD; Salim S. Virani, PhD


Am J Public Health. 2021;111(8):1518-1522. 

In This Article

Abstract and Introduction


Objectives: To examine the disease-specific excess deaths during the COVID-19 pandemic in the United States.

Methods: We used weekly death data from the National Center for Health Statistics to analyze the trajectories of excess deaths from specific diseases in the United States during the COVID-19 pandemic, at the national level and in 4 states, from the first to 52nd week of 2020. We used the average weekly number of deaths in the previous 6 years (2014–2019) as baseline.

Results: Compared with the same week at baseline, the trajectory of number of excess deaths from cardiovascular disease (CVD) was highly parallel to the trajectory of the number of excess deaths related to COVID-19. The number of excess deaths from diabetes mellitus, influenza and respiratory diseases, and malignant neoplasms remained relatively stable over time.

Conclusions: The parallel trajectory of excess mortality from CVD and COVID-19 over time reflects the fact that essential health services for noncommunicable diseases were reduced or disrupted during the COVID-19 pandemic, and the severer the pandemic, the heavier the impact.


In many countries, physical-distancing measures have been adopted to control the COVID-19 pandemic. These measures include stay-at-home orders, closing down mass public transportation systems, and placing restrictions on internal movement.[1] In addition, health care systems have had to adjust standard approaches to care in order to minimize risk to patients and health care personnel, and telehealth has been encouraged.[2] Finally, people with preexisting comorbidities have generally avoided hospitals through fear of contracting the virus. All of these have significantly affected the delivery of services for diagnosis, treatment, and management of noncommunicable diseases (NCDs) globally.[3,4] Hypertension services have been either partially or completely disrupted in 53% of countries, diabetes-related services in 49%, cancer-related services in 42%, and care related to cardiovascular diseases in 31%.[5]

We thus hypothesized that during the peak transmission phase of the COVID-19 pandemic (after March 11, 2020, the day the World Health Organization declared that COVID-19 was a pandemic), health services related to NCD management were disrupted or reduced to a certain extent. This in turn may have led to a higher number of deaths from NCDs. To study this, we assessed the weekly death data in the United States, at the national level and for 4 states, to analyze the trajectories of excess death from specific diseases during the COVID-19 pandemic.