Associations between mortality from COVID-19 and other causes: A state-level analysis

Abstract

Background During the COVID-19 pandemic, the high death toll from COVID-19 was accompanied by a rise in mortality from other causes of death. The objective of this study was to identify the relationship between mortality from COVID-19 and changes in mortality from specific causes of death by exploiting spatial variation in these relationships across US states. Methods We use cause-specific mortality data from CDC Wonder and population estimates from the US Census Bureau to examine relationships at the state level between mortality from COVID-19 and changes in mortality from other causes of death. We calculate age-standardized death rates (ASDR) for three age groups, nine underlying causes of death, and all 50 states and the District of Columbia between the first full year of the pandemic (March 2020-February 2021) and the year prior (March 2019-February 2020). We then estimate the relationship between changes in cause-specific ASDR and COVID-19 ASDR using linear regression analysis weighted by the size of the state’s population. Results We estimate that causes of death other than COVID-19 represent 19.6% of the total mortality burden associated with COVID-19 during the first year of the COVID-19 pandemic. At ages 25+, circulatory disease accounted for 51.3% of this burden while dementia (16.4%), other respiratory diseases (12.4%), influenza/pneumonia (8.7%) and diabetes (8.6%) also contribute. In contrast, there was an inverse association across states between COVID-19 death rates and changes in death rates from cancer. We found no state-level association between COVID-19 mortality and rising mortality from external causes. Conclusions States with unusually high death rates from COVID-19 experienced an even larger mortality burden than implied by those rates alone. Circulatory disease served as the most important route through which COVID-19 mortality affected death rates from other causes of death. Dementia and other respiratory diseases made the second and third largest contributions. In contrast, mortality from neoplasms tended to decline in states with the highest death rates from COVID-19. Such information may help to inform state-level responses aimed at easing the full mortality burden of the COVID-19 pandemic.

Immigrant mortality advantage in the United States during the first year of the COVID-19 pandemic

“…However, our results clearly demonstrate increases in mortality not only from COVID-19 but also from several other causes of death. Consistent with other studies (Luck 2023b), we find that COVID-19 mortality was not accompanied by declines in mortality from other causes, suggesting that the impact of the pandemic extended to mortality beyond the infection itself.…”

Excess natural-cause mortality in US counties and its association with reported COVID-19 deaths

“…If these causes of death declined, reported COVID-19 mortality would exceed excess natural-cause mortality. Second, such a finding could be partially explained by mortality selection (i.e., premature mortality from COVID-19 for some individuals who would have otherwise died several months later of another natural cause) ( 25 ). Last, some death investigators may have listed COVID-19 on death certificates when a person had COVID-19 but did not die from COVID-19 due to differences in state protocols.…”

“…Natural causes include diseases and chronic conditions, whereas external causes consist of intentional and unintentional injuries ( 24 ). SARS-CoV-2 infection is unlikely to lead to excess deaths from external causes in the short term ( 25 , 26 ). Therefore, differences between excess natural-cause deaths and reported COVID-19 deaths may represent a more plausible estimate of unrecognized COVID-19 deaths than comparisons that include external causes.…”

COVID-19 and All-Cause Mortality by Race, Ethnicity, and Age Across Five Periods of the Pandemic in the United States

“… Truman (2022) showed that, while the burden on Black and Hispanic individuals relative to White individuals remained high across the entire 2020 year, the early Asian COVID-19 disadvantage disappeared. In particular, research documented a distinctly heavy burden of COVID-19 mortality on Hispanic individuals during the first year of pandemic, particulaly working-age Hispanic individuals, who experienced some of the largest losses of life from COVID-19 ( Aburto et al, 2022 ; Luck et al, 2023 ).…”

“…However, the pandemic’s mortality impact in 2020 was not limited to deaths attributable to COVID-19. A large body of work also documented substantial increases during the first year of the pandemic in non-COVID-19 mortality across a variety of causes of death, including heart disease, diabetes, drug overdose, and homicide ( Aburto et al, 2022 ; Ahmad & Anderson, 2021 ; Faust et al, 2021 ; Luck et al, 2022 , 2023 ; Shiels et al, 2021 ; Woolf et al, 2020 ). While Hispanic individuals saw the highest rates of COVID-19 in 2020, Black individuals saw the largest increases in all-cause mortality, with nearly a third of that increase found to be attributable to causes other than COVID-19, such as heart disease, diabetes, and external causes ( Chen et al, 2022a , 2022b ; Luck et al, 2022 ).…”