Association of Health Care Factors With Excess Deaths Not Assigned to COVID-19 in the US

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

doi:10.1001/jamanetworkopen.2021.25287

Cited by 28 publications

(37 citation statements)

References 5 publications

(11 reference statements)

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“…Despite having levels of Covid-19 incidence and mortality below those of Hispanic individuals, Black individuals saw the largest absolute increase in all-cause mortality, a pattern consistent with previous work ( Price-Haywood et al, 2020 ; Rossen, 2021 ; Stokes, Lundberg, Bor, Elo, et al, 2021 ). In addition to Covid-19, this increase is substantially attributable to causes other than Covid-19, highlighting the ways that the Covid-19 pandemic may have indirectly shaped mortality among Black communities.…”

Section: Discussionsupporting

confidence: 87%

“…Another explanation of changing death rates in 2020 relates to the process by which underlying cause of death is assigned on death certificates. Some jurisdictions across the U.S., especially early in the pandemic, required a positive test result for a death to be assigned to Covid-19 and thus an absence of testing may have led to a death being assigned to a comorbid chronic condition such as diabetes or heart disease ( Stokes, Lundberg, Bor, Elo, et al, 2021 ). Accurate cause of death assignment is also complicated by the large number of home deaths, especially among racial/ethnic minority populations ( Pathak et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Although the disparities in Covid-19 deaths are well-documented, studies that only consider deaths directly attributable to Covid-19 may obscure the overall magnitude of racial/ethnic disparities in the impact of Covid-19 on mortality for several reasons. First, Covid-19 death counts do not capture the indirect impact of the pandemic on mortality, driven by increased economic and housing hardship, worsened mental health, and reductions in healthcare access ( Anderson et al, 2021 ; Cantor et al, 2020 ; Stokes, Lundberg, Bor, Elo, et al, 2021 ). Second, official Covid-19 death counts fail to capture Covid-19 deaths that were misclassified to other causes of death.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The unequal burden of the Covid-19 pandemic: Capturing racial/ethnic disparities in US cause-specific mortality

Luck

Preston

Elo

et al. 2022

SSM - Population Health

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Despite a growing body of literature focused on racial/ethnic disparities in Covid-19 mortality, few previous studies have examined the pandemic's impact on 2020 cause-specific mortality by race and ethnicity. This paper documents changes in mortality by underlying cause of death and race/ethnicity between 2019 and 2020. Using age-standardized death rates, we attribute changes for Black, Hispanic, and White populations to various underlying causes of death and show how these racial and ethnic patterns vary by age and sex. We find that although Covid-19 death rates in 2020 were highest in the Hispanic community, Black individuals faced the largest increase in all-cause mortality between 2019 and 2020. Exceptionally large increases in mortality from heart disease, diabetes, and external causes of death accounted for the adverse trend in all-cause mortality within the Black population. Within Black and White populations, percentage increases in all-cause mortality were similar for men and women, as well as for ages 25–64 and 65+. Among the Hispanic population, however, percentage increases in mortality were greatest for working-aged men. These findings reveal that the overall impact of the pandemic on racial/ethnic disparities in mortality was much larger than that captured by official Covid-19 death counts alone.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The unequal burden of the Covid-19 pandemic: Capturing racial/ethnic disparities in US cause-specific mortality

Luck

Preston

Elo

et al. 2022

SSM - Population Health

Self Cite

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“…COVID-19 related mortality differed across health systems globally, and it has been proposed that underreporting of COVID-19 mortality is most pronounced in developing countries ( 55 , 56 ), possibly due to limited access to testing or reporting ( 44 , 57 ). Excess general mortality also differs between countries ( 45 , 58 ), and even in the United States, approximately 20% of excess deaths in 2020 were not reflected in COVID-19 death counts, suggesting imprecise cause-of-death attribution during the pandemic ( 59 , 60 ). In this context, it is interesting to mention that mortality data is accessible for many countries, but few countries keep continuous death records for longer time periods.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Autopsies Reveal Underreporting of SARS-CoV-2 Infection and Scarcity of Co-infections

Schwab¹,

Nienhold²,

Henkel

et al. 2022

Front. Med.

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Coronavirus disease 2019 (COVID-19) mortality can be estimated based on reliable mortality data. Variable testing procedures and heterogeneous disease course suggest that a substantial number of COVID-19 deaths is undetected. To address this question, we screened an unselected autopsy cohort for the presence of SARS-CoV-2 and a panel of common respiratory pathogens. Lung tissues from 62 consecutive autopsies, conducted during the first and second COVID-19 pandemic waves in Switzerland, were analyzed for bacterial, viral and fungal respiratory pathogens including SARS-CoV-2. SARS-CoV-2 was detected in 28 lungs of 62 deceased patients (45%), although only 18 patients (29%) were reported to have COVID-19 at the time of death. In 23 patients (37% of all), the clinical cause of death and/or autopsy findings together with the presence of SARS-CoV-2 suggested death due to COVID-19. Our autopsy results reveal a 16% higher SARS-CoV-2 infection rate and an 8% higher SARS-CoV-2 related mortality rate than reported by clinicians before death. The majority of SARS-CoV-2 infected patients (75%) did not suffer from respiratory co-infections, as long as they were treated with antibiotics. In the lungs of 5 patients (8% of all), SARS-CoV-2 was found, yet without typical clinical and/or autopsy findings. Our findings suggest that underreporting of COVID-19 contributes substantially to excess mortality. The small percentage of co-infections in SARS-CoV-2 positive patients who died with typical COVID-19 symptoms strongly suggests that the majority of SARS-CoV-2 infected patients died from and not with the virus.

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“…However, unexpected local or global events, similar to the pandemic situation that emerged during the last two years have raised new challenges, when the sudden acute necessity of intensive care units and specialized medical staff was redirected to provide specific medical care for the patients with severe COVID-19 infections ( 15 ). The limited access of patients to appropriate treatment had negative, occasionally even dramatic, consequences for patients with other types of diseases, including patients with HNC ( 25 ). The massive redirection of intensive care equipment and trained staff for the management of continuously rising number of COVID-19 patients led to a major reduction, and at certain moments even cessation, of non-emergency surgeries.…”

Section: Discussionmentioning

confidence: 99%

A combination of two regional flaps for the complex reconstruction after head and neck cancer surgery as an alternative approach during the COVID‑19 pandemic: A case report

Căruntu¹,

Moraru²,

Comăneanu

et al. 2022

Exp Ther Med

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Since the COVID-19 pandemic outbreak, the medical systems were challenged by continuously increasing numbers of infections and faced critical issues when trying to find solutions for patients suffering from other diseases, including patients with head and neck cancers. Complex surgeries were delayed due to an acute deficit of specialized intensive care medical staff and equipment, which were redirected towards COVID-19 hospitalized cases, with irreversible consequences for the patients. In the present study, the case of locally advanced head and neck cancer was presented, which was treated radically during the heaviest wave of the COVID-19 pandemic in Romania using an alternative approach for immediate defect reconstruction. The case of locally advanced buccal carcinoma (staged T4aN0Mx) was reported, where radical tumor excision was followed by immediate reconstruction using a combination of two regional flaps, temporal and submental, in order to provide timely and optimal medical care. In the difficult context of the COVID-19 pandemic, the standard reconstructive technique, which is the free vascularized tissue transfer, could not be performed for this patient, due to the acute deficit of anesthetists and associated medical staff, as well as the lack of free beds in intensive care units. Combinations of local and regional flaps, such as temporal muscle flap and submental flap, are simple and accessible surgical techniques that require reduced surgical time, minimal equipment, and basic surgical training, advantages that become crucial in historically challenging times, such as a global pandemic. Individual cases, like elderly patients or patients with severe comorbidities, should be considered for these types of reconstructive techniques: simple solutions, single or in combination, which may be an improved therapeutic option for these patients.

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Association of Health Care Factors With Excess Deaths Not Assigned to COVID-19 in the US

Abstract: This cross-sectional study assesses health care factors associated with excess deaths not assigned to COVID-19 in US counties in 2020.

Cited by 28 publications

References 5 publications

The unequal burden of the Covid-19 pandemic: Capturing racial/ethnic disparities in US cause-specific mortality

The unequal burden of the Covid-19 pandemic: Capturing racial/ethnic disparities in US cause-specific mortality

COVID-19 Autopsies Reveal Underreporting of SARS-CoV-2 Infection and Scarcity of Co-infections

A combination of two regional flaps for the complex reconstruction after head and neck cancer surgery as an alternative approach during the COVID‑19 pandemic: A case report

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