County-level estimates of excess mortality associated with COVID-19 in the United States

Ackley, Calvin A.; Lundberg, Dielle J.; Ma, Lei; Elo, Irma T.; Preston, Samuel H.; Stokes, Andrew

doi:10.1016/j.ssmph.2021.101021

Cited by 37 publications

(61 citation statements)

References 29 publications

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“…Islam et al reported 458,000 excess deaths during 2020, which is close to our estimate (25). A prior estimate by Stokes et al found 438,386 excess deaths in 2020, which is lower than our estimate due to differences in methods and time horizons for predicting expected deaths (4).…”

Section: Discussioncontrasting

confidence: 92%

Monthly excess mortality across counties in the United States during the Covid-19 pandemic, March 2020 to February 2022

Paglino¹,

Lundberg²,

Cho³

et al. 2022

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Official Covid-19 death tallies have underestimated the mortality impact of the Covid-19 pandemic in the United States. Excess mortality, which compares observed deaths to deaths expected in the absence of the pandemic, is a useful measure for assessing the total effect of the pandemic on mortality levels. In the present study, we produce county-level estimates of excess mortality for 3,127 counties between March 2020 and December 2021. We fit two hierarchical linear models to county-level death rates from January 2015 to December 2019 and predict expected deaths for each month during the pandemic. We compare these estimates with the observed numbers of deaths to obtain excess deaths for each county-month. An estimated 936,911 excess deaths occurred during 2020 and 2021, of which 171,168 were not assigned to Covid-19 on death certificates. Urban counties in the Far West, Great Lakes, Mideast, and New England experienced a substantial urban mortality disadvantage in 2020, whereas rural counties in these regions had higher mortality in 2021. In the Southeast, Southwest, Rocky Mountain, and Plains regions, there was a rural mortality disadvantage in 2020, which was exacerbated in 2021. The proportion of excess deaths assigned to Covid-19 was lower in 2020 (76.3%) than in 2021 (87.0%), suggesting fewer Covid-19 deaths went unassigned later in the pandemic. However, in rural areas and in the Southeast and Southwest a large share of excess deaths were still not assigned to Covid-19 during 2021.

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Section: Discussioncontrasting

confidence: 92%

Monthly excess mortality across counties in the United States during the Covid-19 pandemic, March 2020 to February 2022

Paglino¹,

Lundberg²,

Cho³

et al. 2022

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“…Even though the contribution of these changes in mortality from other causes declined to 56,219 excess deaths in 2021, from 89,956 the previous year, those still represented 19.6% of the total 2017-2021 increase in excess deaths. Early in the pandemic, the increased contribution of other-cause mortality might have reflected the under-reporting of Covid-19 deaths in the United States, 8 to a degree similar to that observed only in the most affected West European countries (Italy and Spain). Over time, however, trends in mortality from other causes appeared to diverge indeed.…”

Section: Discussionmentioning

confidence: 91%

Another doubling of excess mortality in the United States relative to its European peers between 2017 and 2021

Heuveline

2022

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Importance Previous studies have shown the pre-pandemic emergence of a gap in mortality between the United States and other high-income nations. This gap was estimated to account for nearly one in seven US deaths in 2017. Objective The number and proportion of US deaths that can be attributed to this gap is expected to have grown during the pandemic. This study aims at quantifying this growth at the end of 2021. Design This cross-sectional study uses publicly available 2017 to 2021 data on deaths from all causes and 2020-2021 Covid-19 death counts in the United States and five European countries. Number of deaths are combined with publicly available estimates of population size by sex and age group in these European countries to produce sex- and age-specific mortality rates. These rates are averaged and applied to the US population by sex and age-group to compare the resulting and actual US death counts. Setting The United States and the five most populous countries in Western Europe. Participants All deceased individuals in these countries are included in the death counts. This study does not use individual records. Intervention None. Main Outcome and Measure Total number of US deaths and their counterfactuals when substituting average sex- and age-specific mortality rates for the European countries to those that prevailed in the United States. Results The counterfactuals reveal 711,109 to 747,783 excess deaths in the United States in 2021, amounting to 20.8% to 21.7% of all US deaths that year (3,426,249). Excess deaths increased by 320,436 to 331,477 between 2017 and 2021, 80.0% to 82.7% more than the 2017 estimate. A decomposition of the lower figure showed that population change contributed little to the 2017-2021 increase in excess deaths (33,545 additional deaths). Covid-19 mortality alone continue contributed 230,672 excess deaths in 2021, more than 2020, whereas other causes of deaths contributed 56,219 more excess deaths in 2021 than in 2017. Discussion The proportion of US deaths that would be avoided if the United States could achieve the mortality of its West European counterparts surged to more than one in five during the pandemic. The large and still growing contribution of Covid-19 to excess mortality in the United States is consistent with vaccination rates plateauing at lower levels than in European countries. The overall increase in mortality from other causes during the pandemic increasingly separates the United States from West European countries as well.

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“…The overall proportion is highest in Northeast (92%), and is greater than 100% in the third and fourth period (109% and 121% respectively. This is probably because some people who died of another primary cause had a positive COVID-19 test and were included in the reported counts [7], as called for by the National Center for Health Statistics [8].…”

Section: Resultsmentioning

confidence: 99%

COVID-19 mortality in the United States: It’s been two Americas from the start

Stoto

Schlageter

Kraemer

2022

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During the summer of 2021, a narrative of "two Americas" emerged: one with high demand for the COVID-19 vaccine and the second with widespread vaccine hesitancy and opposition to masks and vaccines. We analyzed "excess mortality" rates (the difference between total deaths and what would have been expected based on earlier time periods) prepared by the CDC for the United States from January 3, 2020 to September 26, 2021. Between Jan. 3, 2020 and Sept. 26, 2021, there were 895,693 excess deaths associated with COVID-19, 26% more than reported as such. The proportion of deaths estimated by the excess mortality method that were reported as COVID-19 was highest in Northeast (92%) and lowest in the West (72%) and South (76%). Of the estimated deaths, 43% occurred between Oct. 4, 2020 and Feb. 27, 2021. Before May 31, 2020, approximately 56% of deaths were in the Northeast, where 17% of the population resides. Subsequently, 48% of deaths were in the South, which makes up 38% of the population. Since May 31, 2020, the South experienced COVID-19 mortality 26% higher than the national rate, whereas the Northeast’s rate was 42% lower. If each region had the same mortality rate as the Northeast, more than 316,234 COVID-19 deaths between May 31, 2020 and Sept. 26, 2021 were "avoidable." More than half (63%) of the avoidable deaths occurred between May 31, 2020 and February, 2021, and more than half (60%) were in the South. Regional differences in COVID-19 mortality have been strong throughout the pandemic. The South has had higher mortality rates than the rest of the U.S. since May 31, 2020, and experienced 62% of the avoidable deaths. A comprehensive COVID-19 policy, including population-based restrictions as well as vaccines, is needed to control the pandemic.

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County-level estimates of excess mortality associated with COVID-19 in the United States

Cited by 37 publications

References 29 publications

Monthly excess mortality across counties in the United States during the Covid-19 pandemic, March 2020 to February 2022

Monthly excess mortality across counties in the United States during the Covid-19 pandemic, March 2020 to February 2022

Another doubling of excess mortality in the United States relative to its European peers between 2017 and 2021

COVID-19 mortality in the United States: It’s been two Americas from the start

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