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US excess all-cause mortality exceeded COVID-19 mortality at 145/100 000 and exceeded peer countries in all periods, as did excess all-cause mortality in the least-vaccinated states (Table 2). However, the 10 most-vaccinated states had excess all-cause mortality comparable with or less than that of several peer countries over Delta and Omicron combined (eg, Denmark, Germany, the Netherlands, Austria, Italy, Finland). While excess all-cause mortality in the top 10 states significantly exceeded that of many comparators during Omicron, excess all-cause mortality was significantly less than COVID-19 mortality for the top 10 states during this wave (29 vs 47 per 100 000, P < .001).

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