Assessing the Impact of the Covid-19 Pandemic on US Mortality: A County-Level Analysis

Stokes, Andrew; Lundberg, Dielle J.; Hempstead, Katherine; Elo, Irma T.; Preston, Samuel H.

doi:10.1101/2020.08.31.20184036

Cited by 34 publications

(35 citation statements)

References 47 publications

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“…Analysis of excess mortality in the US [1][2][3] and in other countries [4,5] has been done to try and show an accurate picture of the mortality effects of COVID-19, which may be masked, for example, in younger age groups. The OECD has published a working paper on excess mortality in 29 countries through the end of September, to help measure the direct and indirect impact of COVID-19 [6].…”

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confidence: 99%

Excess mortality during the COVID-19 pandemic in Israel, March–November 2020: when, where, and for whom?

Haklai

Aburbeh

Goldberger

et al. 2021

Isr J Health Policy Res

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Background Excess all-cause mortality has been used in many countries as an estimate of mortality effects from COVID-19. What was the excess mortality in Israel in 2020 and when, where and for whom was this excess? Methods Mortality rates between March to November 2020 for various demographic groups, cities, month and week were compared with the average rate during 2017–2019 for the same groups or periods. Results Total mortality rates for March–November were significantly higher by 6% in 2020, than the average of 2017–2019, 14% higher among the Arab population and 5% among Jews and Others. Significantly higher monthly mortality rates were found in August, September and October by 11%, 13% and 19%, respectively, among Jews and Others, and by 19%, 64% and 40% in the Arab population. Excess mortality was significant only at older ages, 7% higher rates at ages 65–74 and 75–84 and 8% at ages 85 and above, and greater for males than females in all ages and population groups. Interestingly, mortality rates decreased significantly among the younger population aged under 25. The cities with most significant excess mortality were Ramla (25% higher), Bene Beraq (24%), Bat Yam (15%) and Jerusalem (8%). Conclusion Israel has seen significant excess mortality in August–October 2020, particularly in the Arab sector. The excess mortality in March–November was statistically significant only at older ages, over 65. It is very important to protect this susceptible population from exposure and prioritize them for inoculations. Lockdowns were successful in lowering the excess mortality. The excess mortality is similar to official data on COVID-19 deaths.

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confidence: 99%

Excess mortality during the COVID-19 pandemic in Israel, March–November 2020: when, where, and for whom?

Haklai

Aburbeh

Goldberger

et al. 2021

Isr J Health Policy Res

View full text Add to dashboard Cite

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“…Excess risk of COVID-19 and COVID-19 related death in the United States has been associated with lower income status and non-white ethnicity, but similar relationships have been observed in Canada as well (6, 7). A second key limitation of our analysis is our use of Ontario-specific case fatalities, and hospitalization and intensive care admission risks, to estimate outcomes averted at a national level; however, Ontario's epidemiology is likely similar to that of Canada overall, both because of similarities in demographics and health systems across the country, and also because the population of Ontario represents approximately 40% of the Canadian population, and 35% of United States occurs in a comparable manner; questions around over-and under-assignment of COVID-19 mortality have been raised in both countries (8).…”

Section: Discussionmentioning

confidence: 99%

“…A second key limitation of our analysis is our use of Ontario-specific case fatalities, and hospitalization and intensive care admission risks, to estimate outcomes averted at a national level; however, Ontario’s epidemiology is likely similar to that of Canada overall, both because of similarities in demographics and health systems across the country, and also because the population of Ontario represents approximately 40% of the Canadian population, and 35% of Canada’s COVID-19 case load, such that the Province’s epidemiology strongly influences that of Canada as a whole. Lastly, we assume that attribution of COVID-19 deaths in Canada and the United States occurs in a comparable manner; questions around over- and under-assignment of COVID-19 mortality have been raised in both countries (8).…”

Section: Discussionmentioning

confidence: 99%

Relative Pandemic Severity in Canada and Four Peer Nations During the SARS-CoV-2 Pandemic

Fisman

Tuite

2021

Preprint

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Cross-border comparisons of healthcare structure and outcomes between Canada and the United States have yielded important insights into strengths and weaknesses of their respective health systems. Canada's approach to control of the SARS-CoV-2 pandemic was more successful than that of the United States in terms of mortality. We standardized US mortality risk to the Canadian population, in order to estimate hospitalizations, ICU admissions and deaths Canada averted by outperforming the United States in this regard. We estimate that Canada averted some 45,000 deaths, 185,000 hospital admissions and 38,000 intensive care admissions. Notably, the deaths averted were concentrated in adults in the 50-75 year age group.

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“…Accordingly, racial disparities have remained a core part of national discussion. As of January 24th, 2021, the national per capita COVID-19 mortality for Black Americans is 1.47 times that of White Americans (Stokes et al, 2021). However, cross-sectional studies over different intervals during the pandemic suggest that there has been a recent convergence between White and Black mortality (Bassett et al, 2020; Gross et al, 2020; Webb Hooper et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

“…Cross-sectional studies have also linked racial disparities in COVID-19 mortality to a variety of community-level factors including population density and urbanization. Black Americans often live in dense urban environments that can increase exposure to COVID-19 (Adhikari et al, 2020; Kirby, 2020; Stokes et al, 2021). Other studies have tied COVID-19 racial disparities to differences in access to care, economic status, chronic comorbidities, and “essential worker” categorization (Cheng et al, 2020; Paul et al, 2020; Wright et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Understanding Convergence Between Non-Hispanic Black and White COVID-19 Mortality: A County-Level Approach

Lawton

Zheng

et al. 2021

Preprint

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Background: Non Hispanic Black populations have suffered greater per capita COVID19 mortality at more than 1.5 times that of White populations. Previous work has established that, over time, rates of Black and White mortality have converged; however, some studies suggest that regional shifts in COVID19 prevalence may play a role in the relative change between racial groups. The study objective was to investigate changes in Black and White COVID19 mortality over time and uncover potential mechanisms driving these changes. Methods and Findings: Using county level COVID-19 mortality data stratified by race, we investigate the trajectory of non Hispanic Black mortality, White mortality, and the Black/White per capita mortality ratio from June 2020 to January 2021. Over this period, in the counties studied, cumulative mortality rose by 56.7% and 82.8% for Black and White populations respectively, resulting in a decrease in mortality ratio of 0.369 (23.8%). These trends persisted even when a county-level fixed-effects model was used to estimate changes over time within counties (controlling for all time invariant county level characteristics and removing the effects of changes in regional distribution of COVID19). Next, we leverage county level variation over time in COVID19 prevalence to show that the declines in the Black/White mortality ratio can be explained by changes in COVID19 prevalence. Finally, we study heterogeneity in the time trend, finding that convergence occurs most significantly in younger populations, areas with less dense populations, and outside of the Northeast. Limitations include suppressed data in counties with fewer than 10 deaths in a racial category, and the use of provisional COVID19 death data that may be incomplete. Conclusions: The results of this study suggest that convergence in Black/White mortality is not driven by county level characteristics or changes in the regional dispersion of COVID19, but instead by changes within counties. Further, declines in the Black/White mortality ratio appear strongly linked to changes in COVID19 prevalence, rather than a time specific effect. Further studies on changes in exposure by race over time, or on the vulnerability of individuals who died at different points in the pandemic, may provide crucial insight on mechanisms and strategies to further reduce COVID19 mortality disparities.

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Assessing the Impact of the Covid-19 Pandemic on US Mortality: A County-Level Analysis

Cited by 34 publications

References 47 publications

Excess mortality during the COVID-19 pandemic in Israel, March–November 2020: when, where, and for whom?

Excess mortality during the COVID-19 pandemic in Israel, March–November 2020: when, where, and for whom?

Relative Pandemic Severity in Canada and Four Peer Nations During the SARS-CoV-2 Pandemic

Understanding Convergence Between Non-Hispanic Black and White COVID-19 Mortality: A County-Level Approach

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