{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T17:48:11Z","timestamp":1792259291931,"version":"4.4.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The COVID-19 pandemic disrupted long-term mortality declines. Preliminary 2024 data indicate a return to prepandemic trends, but part of this reduction may reflect mortality displacement, in which frail or high-risk individuals died earlier than they otherwise would have during the pandemic, possibly leading to temporarily fewer deaths in subsequent years.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To estimate global all-cause mortality trends during and after COVID-19 and assess the association of mortality displacement with mortality declines seen in 2023 and 2024.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cross-national, cross-sectional time-series study assessed mortality data from January 2015 to December 2024, with January 2015 to December 2019 serving as the prepandemic baseline for country-specific, age-adjusted linear projections of expected mortality. Countries were included with high-quality national mortality reporting from the Human Mortality Database Short-Term Mortality Fluctuations. Total populations for each country were stratified by sex and age (0-14 years, 15-64 years, 65-74 years, 75-84 years, and \u226585 years).<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n The COVID-19 pandemic years (2020-2022 or 2020-2023) and postpandemic years (2023-2024 or 2024 alone), relative to a 2015-to-2019 prepandemic baseline.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Excess mortality is defined as actual minus expected mortality, in which expected deaths were projected from prepandemic (2015-2019) data using an overdispersed Poisson regression model. Mortality displacement was defined as a statistically significant postpandemic mortality deficit in 2023 and 2024 (or in 2024) following a positive excess mortality during the 2020-2022 (or 2020-2023) pandemic period. To quantify the magnitude of mortality displacement, the mortality displacement ratio was defined as the ratio of the cumulative postpandemic deficit to the cumulative pandemic-period excess.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n This study included 352\u202f182\u202f284 deaths across 34 countries from 2015 to 2024, with a median (IQR) 2020 population composition of 50.75% (50.33%-51.44%) female and 19.64% (17.74%-20.64%) aged 65 years or older. Statistically significant mortality displacement was detected in 3 of 34 countries (Greece: 10% [95% CI, 4%-15%], Latvia: 21% [95% CI, 14%-28%], and Poland: 21% [95% CI, 17%-25%]), predominantly among adults aged 85 years or older and in strata in the highest quintile of COVID-19\u2013era excess mortality. In 2024, the US returned to its prepandemic pattern of stable mortality, with an excess mortality rate of 3 (95% CI, \u22122 to 7) per 100\u202f000. In contrast, most European countries had not yet resumed their prepandemic trajectories, exhibiting excess mortality rates ranging from 11 (95% CI, 3-18) per 100\u202f000 in France to 115 (95% CI, 94-135) per 100\u202f000 in Lithuania.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of 34 countries, postpandemic mortality declines were rarely associated with mortality displacement; most European countries had not returned to their prepandemic mortality trajectories by 2024. These results suggest that pandemic strategies should prioritize population-wide protection and highlight the need to understand why so many European countries have failed to resume their pre\u2013COVID-19 pattern of mortality decline.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.55442","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T16:30:30Z","timestamp":1769704230000},"page":"e2555442","source":"Crossref","is-referenced-by-count":8,"title":["Global Assessment of COVID-19 Mortality Displacement From 2020 to 2024"],"prefix":"10.1001","volume":"9","author":[{"given":"Xiyin","family":"Chen","sequence":"first","affiliation":[{"name":"School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Ye","sequence":"additional","affiliation":[{"name":"School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin John","family":"Cowling","sequence":"additional","affiliation":[{"name":"School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Makram","family":"Bishai","sequence":"additional","affiliation":[{"name":"School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"issue":"5570","key":"zoi251476r1","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1126\/science.1069675","article-title":"Demography. broken limits to life expectancy.","volume":"296","author":"Oeppen","year":"2002","journal-title":"Science"},{"issue":"7942","key":"zoi251476r2","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1038\/s41586-022-05522-2","article-title":"The WHO estimates of excess mortality associated with the COVID-19 pandemic.","volume":"613","author":"Msemburi","year":"2023","journal-title":"Nature"},{"issue":"1","key":"zoi251476r3","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1093\/ije\/dyab207","article-title":"Quantifying impacts of the COVID-19 pandemic through life-expectancy losses: a population-level study of 29 countries.","volume":"51","author":"Aburto","year":"2022","journal-title":"Int J Epidemiol"},{"issue":"12","key":"zoi251476r4","doi-asserted-by":"publisher","first-page":"1649","DOI":"10.1038\/s41562-022-01450-3","article-title":"Life expectancy changes since COVID-19.","volume":"6","author":"Sch\u00f6ley","year":"2022","journal-title":"Nat Hum Behav"},{"issue":"4","key":"zoi251476r5","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1162\/rest.91.4.659","article-title":"Extreme weather events, mortality, and migration.","volume":"91","author":"Deschenes","year":"2009","journal-title":"Rev Econ Stat"},{"issue":"1","key":"zoi251476r6","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1080\/00324720701804249","article-title":"The mortality impact of the August 2003 heat wave in France: investigating the \u201charvesting\u201d effect and other long-term consequences.","volume":"62","author":"Toulemon","year":"2008","journal-title":"Popul Stud (Camb)"},{"issue":"4","key":"zoi251476r7","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1093\/aje\/kwt264","article-title":"Mortality displacement as a function of heat event strength in 7 US cities.","volume":"179","author":"Saha","year":"2014","journal-title":"Am J Epidemiol"},{"issue":"5","key":"zoi251476r8","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1093\/oxfordjournals.aje.a010228","article-title":"Harvesting and long term exposure effects in the relation between air pollution and mortality.","volume":"151","author":"Schwartz","year":"2000","journal-title":"Am J Epidemiol"},{"issue":"9","key":"zoi251476r9","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1016\/S1473-3099(22)00320-6","article-title":"Global impact of the first year of COVID-19 vaccination: a mathematical modelling study.","volume":"22","author":"Watson","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"zoi251476r10","doi-asserted-by":"publisher","DOI":"10.1101\/2023.06.20.23291593","article-title":"Comparison of control and transmission of COVID-19 across epidemic waves in Hong Kong: an observational study.","volume":"43","author":"Yang","year":"2023","journal-title":"Lancet Reg Health West Pac"},{"key":"zoi251476r11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11079-021-09638-2","article-title":"The economic effects of COVID-19 containment measures.","volume":"33","author":"Deb","year":"2022","journal-title":"Open Econ Rev"},{"issue":"2","key":"zoi251476r15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2023-013900","article-title":"The economic impact of international travel measures used during the COVID-19 pandemic: a scoping review.","volume":"9","author":"Bazak","year":"2024","journal-title":"BMJ Glob Health"},{"key":"zoi251476r17","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/1744-8603-3-5","article-title":"Globalization and social determinants of health: introduction and methodological background (part 1 of 3).","volume":"3","author":"Labont\u00e9","year":"2007","journal-title":"Global Health"},{"key":"zoi251476r18","doi-asserted-by":"publisher","DOI":"10.31478\/202107e","article-title":"Biomedical research COVID-19 impact assessment: lessons learned and compelling needs.","author":"Cook","year":"2021","journal-title":"NAM Perspect"},{"issue":"1137","key":"zoi251476r19","doi-asserted-by":"publisher","first-page":"n1137","DOI":"10.1136\/bmj.n1137","article-title":"Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries.","volume":"373","author":"Islam","year":"2021","journal-title":"BMJ"},{"key":"zoi251476r20","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.69336","article-title":"Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset.","volume":"10","author":"Karlinsky","year":"2021","journal-title":"Elife"},{"issue":"10","key":"zoi251476r21","doi-asserted-by":"publisher","first-page":"1336","DOI":"10.1001\/jamainternmed.2020.3391","article-title":"Estimation of excess deaths associated with the COVID-19 pandemic in the United States, March to May 2020.","volume":"180","author":"Weinberger","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"5","key":"zoi251476r22","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2025.1118","article-title":"Excess US deaths before, during, and after the COVID-19 pandemic.","volume":"6","author":"Bor","year":"2025","journal-title":"JAMA Health Forum"},{"key":"zoi251476r23","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2022.113754","article-title":"Comparison of pandemic excess mortality in 2020-2021 across different empirical calculations.","volume":"213","author":"Levitt","year":"2022","journal-title":"Environ Res"},{"issue":"1","key":"zoi251476r24","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1038\/s41467-022-35770-9","article-title":"Direct and indirect effects of the COVID-19 pandemic on mortality in Switzerland.","volume":"14","author":"Riou","year":"2023","journal-title":"Nat Commun"},{"issue":"5","key":"zoi251476r26","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1001\/jama.2020.11787","article-title":"Excess deaths from COVID-19 and other causes, March-April 2020.","volume":"324","author":"Woolf","year":"2020","journal-title":"JAMA"},{"issue":"28","key":"zoi251476r27","doi-asserted-by":"publisher","first-page":"8327","DOI":"10.12998\/wjcc.v9.i28.8327","article-title":"Diabetes mellitus and COVID-19: understanding the association in light of current evidence.","volume":"9","author":"Sen","year":"2021","journal-title":"World J Clin Cases"},{"key":"zoi251476r28","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.649525","article-title":"COVID-19 and diabetes: understanding the interrelationship and risks for a Severe course.","volume":"12","author":"Landstra","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"zoi251476r29","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1146\/annurev-med-042220-011857","article-title":"COVID-19 and diabetes.","volume":"73","author":"Singh","year":"2022","journal-title":"Annu Rev Med"},{"issue":"3","key":"zoi251476r30","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1038\/s41440-023-01557-8","article-title":"Association between blood pressure and COVID-19 severity.","volume":"47","author":"Yoshihara","year":"2024","journal-title":"Hypertens Res"},{"issue":"1","key":"zoi251476r31","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01157-2020","article-title":"The liaison between respiratory failure and high blood pressure: evidence from COVID-19 patients.","volume":"56","author":"Vicenzi","year":"2020","journal-title":"Eur Respir J"},{"issue":"3","key":"zoi251476r32","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1093\/ajh\/hpaa225","article-title":"High systolic blood pressure at hospital admission is an important risk factor in models predicting outcome of COVID-19 patients.","volume":"34","author":"Caillon","year":"2021","journal-title":"Am J Hypertens"},{"issue":"3","key":"zoi251476r33","doi-asserted-by":"publisher","DOI":"10.1016\/j.focus.2024.100312","article-title":"Heterogeneity of the association between obesity and COVID-19 mortality and the roles of policy interventions: U.S. national-level analysis.","volume":"4","author":"Bhandari","year":"2024","journal-title":"AJPM Focus"},{"issue":"6","key":"zoi251476r34","doi-asserted-by":"publisher","DOI":"10.1111\/cob.12403","article-title":"Obesity: a critical risk factor in the COVID-19 pandemic.","volume":"10","author":"Kwok","year":"2020","journal-title":"Clin Obes"},{"key":"zoi251476r35","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.780872","article-title":"Association of obesity with COVID-19 severity and mortality: an updated systemic review, meta-analysis, and meta-regression.","volume":"13","author":"Singh","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"zoi251476r16","year":"2022"},{"key":"zoi251476r12","unstructured":"Caselli F, Grigoli F, Lian W, Sandri D. Chapter 2: the at lockdown: dissecting the economic effects. In: International Monetary Fund Research Department. World Economic Outlook, October 2020. A Long and Difficult Ascent. International Monetary Fund; 2020. https:\/\/www.elibrary.imf.org\/display\/book\/9781513556055\/ch02.xml"},{"key":"zoi251476r13","unstructured":"World employment and social outlook: trends 2021. International Labour Organization. June 2, 2021. Accessed December 15, 2025. https:\/\/www.ilo.org\/publications\/world-employment-and-social-outlook-trends-2021"},{"key":"zoi251476r14","unstructured":"World Trade Organization. World trade and economic growth, 2021\u201322. World Trade Statistical Review 2022. February 2023. Accessed December 15, 2025. https:\/\/www.wto.org\/english\/res_e\/booksp_e\/wtsr_2022_c3_e.pdf"},{"key":"zoi251476r25","unstructured":"Metreau? E, Young? KE, Eapen? SG. World Bank country classifications by income level for 2024-2025. World Bank. Accessed December 22, 2025. https:\/\/blogs.worldbank.org\/en\/opendata\/world-bank-country-classifications-by-income-level-for-2024-2025"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2844476\/chen_2026_oi_251476_1769100833.23127.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T16:30:32Z","timestamp":1769704232000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2844476"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.55442","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]}}}