目标 估计 2020 年 3 月至 12 月期间美国 17 种根本死因的超额死亡负担，并比较非 COVID 原因与 COVID-19 造成的超额死亡趋势。方法 使用时间序列模型，我们估计了每月全因和特定原因超额死亡人数。我们按地理区域进行分层，并将非 COVID 原因导致的过量死亡的时间趋势与 COVID-19 导致的死亡趋势进行比较。结果 在大约 500,000 例额外死亡中，70% 归因于 COVID-19。我们观察到几种根本死因的增加，从肾病死亡增加 3% 到凶杀增加 24%，以及癌症 (-0.3%)、流感和肺炎 (-2%) 死亡人数下降、慢性下呼吸道疾病（-3%）和自杀（-7%）。心血管疾病、糖尿病和阿尔茨海默病的超额死亡趋势与 COVID-19 的死亡趋势密切相关。肝病过多、他杀、自杀和机动车事故死亡的趋势与 COVID-19 死亡的趋势呈负相关。某些死因的超额死亡率存在很大的地区差异，包括五大湖区凶杀和机动车事故死亡人数的不成比例增加，以及中东和新英格兰地区癌症死亡人数的持续减少。结论 2020 年 3 月至 12 月期间，心血管疾病、糖尿病和阿尔茨海默病死亡人数的增加可能反映了医疗保健系统中断或 COVID-19 的急性并发症。凶杀和肝病造成的过多死亡更有可能反映了新出现的流行病或其他单独原因的社会和经济影响。© 作者 2024。由牛津大学出版社代表约翰·霍普金斯大学彭博公共卫生学院出版。版权所有。如需权限，请发送电子邮件至：journals.permissions@oup.com。

Objectives To estimate the burden of excess mortality from 17 underlying causes of death between March-December 2020 in the United States, and to compare trends in excess deaths from non-COVID causes vs. from COVID-19. Methods Using time series models, we estimated monthly counts of all-cause and cause-specific excess deaths. We stratified by geographic region and compared temporal trends in excess deaths from non-COVID causes to trends in deaths attributed to COVID-19. Results Of approximately 500,000 excess deaths, 70% were attributed to COVID-19. We observed increases in several underlying causes of death, ranging from a 3% increase in kidney disease deaths to a 24% increase in homicides, as well as decreases in deaths from cancer (-0.3%), influenza and pneumonia (-2%), chronic lower respiratory disease (-3%), and suicide (-7%). Trends in excess deaths from cardiovascular disease, diabetes, and Alzheimer's disease closely mirrored trends in deaths from COVID-19. Trends in excess liver disease, homicide, suicide, and motor vehicle accident deaths were negatively correlated with trends in deaths from COVID-19. There was wide regional variation in excess death rates for some causes of death, including a disproportionate increase in homicide and motor vehicle accident deaths in the Great Lakes, and a sustained reduction in cancer deaths in the Mideast and New England. Conclusions Increases in cardiovascular disease, diabetes, and Alzheimer's disease deaths from March-December 2020 likely reflect healthcare system disruptions or acute complications of COVID-19. Excess deaths from homicide and liver disease are more likely to reflect social and economic effects of the emerging pandemic, or other separate causes.© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.