Global Trends in Excess Mortality Since 2023

An in-depth analysis of increased death rates across various countries

Key Takeaways

Significant increases in excess mortality are observed in several Western countries, including the US, Europe, and Australia.
Unnatural causes such as drug overdoses and transport-related deaths are major contributors to excess mortality.
Global excess mortality trends are influenced by a combination of COVID-19 impacts, environmental crises, and socio-economic factors.

Overview of Excess Mortality

Excess mortality, also known as excess deaths, refers to the number of deaths above what would be expected based on historical trends for a specific period. Since 2023, numerous countries have reported increased rates of excess mortality, influenced by a variety of factors including lingering effects of the COVID-19 pandemic, socio-economic stresses, and environmental crises.

Countries with Notable Increases in Excess Mortality

United States

The United States has continued to experience increased rates of excess mortality since 2023. Notably, young adults aged 25-44 have seen a 70% higher death rate compared to expected trends. Overall, the death rate remains approximately 20% higher than in 2019. Drug-related deaths are identified as the single largest contributor to this excess mortality. Estimates by the Swiss Re Institute suggest an excess mortality rate between 3-7% in 2023.

European Union

Within the European Union, 23 countries reported excess deaths as of October 2024. The highest rates were observed in Cyprus (17.2%), Austria (17.1%), Malta (16.8%), Germany (14.3%), and the Netherlands (12.8%). Countries like Finland and Cyprus reached excess mortality rates as high as 18.4% and 18.0% respectively by November 2024. Notably, nations such as Poland, Hungary, and Sweden reported lower-than-expected excess death rates.

Australia and New Zealand

Australia and New Zealand have experienced elevated excess mortality rates in 2023, potentially linked to high COVID-19 vaccination rates and other underlying health factors. Denmark has also been noted alongside these countries for similar trends.

Democratic Republic of the Congo (DRC)

The DRC's humanitarian response plan for 2023-2025 indicates ongoing challenges with excess mortality, pointing to persistent health crises and infrastructure issues contributing to increased death rates.

Global Trends and Contributing Factors

Globally, excess mortality remains a pressing concern, with various countries experiencing elevated death rates due to multiple factors:

COVID-19 Pandemic: The long-term impact of the pandemic continues to influence mortality rates, with new variants and lingering health effects contributing to excess deaths.
Unnatural Causes: Increases in deaths from causes such as drug overdoses, transport-related incidents, and alcohol-related deaths have been significant contributors.
Environmental Crises: Extreme weather events like heatwaves are becoming more frequent and intense due to climate change, leading to spikes in mortality during such events.
Healthcare System Strains: Ongoing strains on healthcare systems, particularly in low- and middle-income countries, hinder effective responses to health crises, indirectly increasing mortality rates.

Detailed Country Analysis

Table of Excess Mortality Rates by Country

Country	Excess Mortality Rate (%)	Primary Contributing Factors
United States	3-7%	Drug overdoses, COVID-19 variants
Cyprus	17.2%	COVID-19, environmental factors
Austria	17.1%	Alzheimer's, demographic changes
Malta	16.8%	Healthcare strains, COVID-19
Germany	14.3%	COVID-19, mental health
Netherlands	12.8% (Oct 2024), 13.9% (Nov 2024)	COVID-19 vaccination outcomes, lifestyle factors
Finland	18.4%	COVID-19, economic stress
Denmark	Data N/A	COVID-19-related factors
Australia	Data N/A	COVID-19 vaccination, healthcare issues
New Zealand	Data N/A	COVID-19 vaccination, health system pressures
Poland	Lower-than-expected	Effective public health measures
Hungary	Lower-than-expected	Effective public health measures
Sweden	Lower-than-expected	Effective public health measures

United States: A Closer Look

The United States has seen a substantial rise in excess mortality rates, particularly among young adults aged 25-44, with a 70% increase in death rates in 2023 compared to expected trends. The overall death rate is nearly 20% higher than in 2019. The leading cause of excess mortality in the US is drug-related deaths, which underscores the ongoing opioid crisis and its devastating impact on public health. Additionally, the Swiss Re Institute's estimates of 3-7% excess mortality in 2023 highlight the broader public health challenges the nation faces. These challenges are compounded by socio-economic factors such as unemployment, mental health issues, and inadequate access to healthcare, which collectively contribute to the elevated death rates.

European Union: Diverse Experiences

Within the European Union, excess mortality trends vary widely among member states. As of October 2024, Cyprus, Austria, Malta, Germany, and the Netherlands reported some of the highest rates of excess deaths. Various factors contribute to these increases, including the lingering effects of the COVID-19 pandemic, public health system strains, and socio-economic pressures. For instance, Cyprus reported an excess mortality rate of 17.2%, primarily due to COVID-19 and environmental factors such as extreme heatwaves. Similarly, Austria's rate of 17.1% is influenced by demographic changes and underlying health issues, including a rise in deaths related to Alzheimer's disease and other chronic conditions. Germany's excess mortality rate of 14.3% reflects the combined impact of COVID-19, mental health challenges, and stress on the healthcare system.

Australia, New Zealand, and Denmark

Australia and New Zealand, along with Denmark, have recorded high rates of excess mortality in 2023. These increases are partly attributed to high COVID-19 vaccination rates, which have had complex interactions with public health outcomes. In Australia, the rapid vaccination rollout initially helped control the spread of the virus, but subsequent waves and vaccine hesitancy in certain populations have led to spikes in mortality rates. New Zealand has faced similar challenges, with healthcare system pressures exacerbated by COVID-19 outbreaks and other health crises. Denmark's excess mortality data, while not as detailed, indicates trends similar to its neighboring countries, with COVID-19-related factors playing a significant role.

Democratic Republic of the Congo (DRC)

In the Democratic Republic of the Congo, excess mortality remains a critical issue as outlined in the country's humanitarian response plan for 2023-2025. The ongoing health crises, including outbreaks of diseases like Ebola and measles, coupled with inadequate healthcare infrastructure and limited access to medical services, contribute to a high rate of excess deaths. Additionally, socio-economic challenges such as poverty, food insecurity, and political instability exacerbate the situation, making it difficult to address the root causes of excess mortality effectively.

Global Contributing Factors to Excess Mortality

Multiple factors contribute to the observed increases in excess mortality rates globally:

COVID-19 Pandemic: The pandemic's prolonged effects, including the emergence of new variants and long COVID, continue to impact mortality rates. Countries with high vaccination rates have still grappled with excess deaths due to various factors such as vaccine distribution challenges and emerging viral strains.
Unnatural Causes: The rise in deaths from unnatural causes, such as drug overdoses, transport-related incidents, and alcohol-related fatalities, has been significant. These trends highlight the need for comprehensive public health strategies beyond infectious disease control, focusing on mental health support and substance abuse prevention.
Environmental Crises: The increasing frequency and severity of extreme weather events, driven by climate change, have led to temporary but significant spikes in mortality rates during such events. Heatwaves, floods, and storms directly contribute to increased deaths, particularly in regions lacking adequate infrastructure to cope with these challenges.
Socio-Economic Stresses: Economic downturns, unemployment, and associated mental health challenges have indirect effects on mortality rates. Increased incidence of mental health issues can lead to higher rates of suicide and substance abuse, further exacerbating excess mortality.
Healthcare System Strains: The capacity of healthcare systems to respond to ongoing and emerging health challenges plays a critical role. Countries with strained healthcare systems due to lack of resources, workforce shortages, or inadequate infrastructure are more susceptible to higher excess mortality. This is particularly evident in low- and middle-income countries where healthcare access is limited.
Population Demographics: Aging populations in many countries contribute to higher baseline mortality rates, making it more challenging to manage excess mortality during crises. Chronic health conditions prevalent in older populations also increase vulnerability to health emergencies.

Future Outlook and Recommendations

Given the persistent trends in excess mortality since 2023, it is crucial for governments and international bodies to focus on multifaceted strategies to mitigate these increases. Recommendations include:

Enhancing Public Health Infrastructure: Strengthening healthcare systems to better respond to both infectious diseases and other health crises. This includes increasing funding for healthcare services, training medical personnel, and improving healthcare accessibility.
Addressing Drug Overdoses: Implementing comprehensive strategies to combat the opioid crisis and other substance abuse issues. This can involve expanding access to addiction treatment, increasing public awareness campaigns, and enforcing regulations on prescription medications.
Climate Change Mitigation: Tackling environmental factors that contribute to excess mortality, such as through investment in climate resilience measures, reducing greenhouse gas emissions, and enhancing disaster preparedness.
Economic Support Measures: Providing economic support to reduce socio-economic stresses that indirectly contribute to excess deaths. This includes unemployment benefits, mental health services, and social safety nets to support vulnerable populations.
Data Collection and Analysis: Improving the accuracy and timeliness of mortality data to better understand and respond to excess mortality trends. Enhanced data collection can aid in identifying emerging health threats and evaluating the effectiveness of interventions.
Promoting Mental Health: Increasing access to mental health services and reducing the stigma associated with seeking help. Mental health support can help address issues like depression, anxiety, and substance abuse that contribute to excess mortality.
International Collaboration: Strengthening international cooperation to address global health challenges. Sharing best practices, resources, and information can enhance the collective ability to manage excess mortality.

Conclusion

Since 2023, several countries have faced increased rates of excess mortality driven by a confluence of factors, including the lingering impacts of the COVID-19 pandemic, rises in unnatural causes of death, environmental crises, and socio-economic challenges. Addressing these issues requires coordinated efforts at both national and international levels, focusing on bolstering healthcare systems, combating substance abuse, mitigating climate change, and alleviating economic stresses. Continued monitoring and analysis of mortality data are essential to effectively address and reduce excess mortality rates globally. Proactive measures, informed by comprehensive data and international cooperation, will be key to reversing these troubling trends and improving global public health outcomes.

References

Australian Bureau of Statistics - Provisional Mortality Statistics
DRC Humanitarian Response Plan 2023-2025
World Health Organization - Global Excess Deaths
European Commission - Excess Mortality Statistics
Society of Actuaries - Mortality Improvement Update
BMJ Group - Excess Death Rates in the West
US News - Early Adult Mortality
Medical Express - Early Adult Mortality
Swiss Re Institute - COVID-19 and Excess Mortality
Eurostat - Excess Mortality