Excess Deaths During the COVID-19 Pandemic: Implications for US Death Investigation Systems

Stokes, Andrew; Lundberg, Dielle J.; Bor, Jacob; Bibbins‐Domingo, Kirsten

doi:10.2105/ajph.2021.306331

Cited by 25 publications

(37 citation statements)

References 10 publications

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“…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 ). Deaths occurring at home are more likely to be certified by a local coroner, who may lack medical training and has limited resources for performing post-mortem testing or autopsies ( Stokes, Lundberg, Bor, & Bibbins-Domingo, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…This indicates that there were excess deaths not assigned to Covid-19 reported in these regions during 2020. Between pandemic that may have influenced the likelihood of testing (16,22).…”

Section: Discussionmentioning

confidence: 99%

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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“…Second, deaths are registered at the county-level ( Curtin et al, 2019 ; Institute of Medicine. Me, 2003 ; Stokes et al, 2021c ). Thus, it is reasonable to assume that administrative differences may exist between counties in the processing of deaths.…”

Section: Introductionmentioning

confidence: 99%

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

Ackley

Lundberg

et al. 2022

SSM - Population Health

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The COVID-19 pandemic in the U.S. has been largely monitored using death certificates containing reference to COVID-19. However, prior analyses reveal that a significant percentage of excess deaths associated with the pandemic were not directly assigned to COVID-19. In this study, we estimated a generalized linear model of expected mortality based on historical trends in deaths by county of residence between 2011 and 2019. We used the results of the model to generate estimates of excess mortality and excess deaths not assigned to COVID-19 in 2020 for 1470 county sets in the U.S. representing 3138 counties. Across the country, we estimated that 438,386 excess deaths occurred in 2020, among which 87.5% were assigned to COVID-19. Some regions (Mideast, Great Lakes, New England, and Far West) reported the most excess deaths in large central metros, whereas other regions (Southwest, Southeast, Plains, and Rocky Mountains) reported the highest excess mortality in nonmetro areas. The proportion assigned to COVID-19 was lowest in large central metro areas (79.3%). Regionally, the proportion of excess deaths assigned to COVID-19 was lowest in the Southeast (81.6%), Southwest (82.6%), Far West (83.7%), and Rocky Mountains (86.7%). Across the regions, the number of excess deaths exceeded the number of directly assigned COVID-19 deaths in most counties. The exception to this pattern occurred in New England, which reported more directly assigned COVID-19 deaths than excess deaths in large central metro areas, large fringe metros, and medium or small metros. Many county sets had substantial numbers of excess deaths that were not accounted for in direct COVID-19 death counts. Estimates of excess mortality at the local level can inform the allocation of resources to areas most impacted by the pandemic and contribute to positive behavior feedback loops, such as increases in mask-wearing and vaccine uptake.

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Excess Deaths During the COVID-19 Pandemic: Implications for US Death Investigation Systems

Cited by 25 publications

References 10 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

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

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

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