COVID-19

In many parts of the world, official death tolls undercount the total number of fatalities

Covid-19 excess deaths refer to increases in mortality over what would normally have been expected in the absence of the Covid-19 pandemic. In this study, we take advantage of spatial variation in Covid-19 mortality across US counties to estimate its relationship with all-cause mortality. We then examine how the extent of excess mortality not assigned to Covid-19 varies across subsets of counties defined by demographic and structural characteristics. We estimate that 26.3% [95% CI, 20.1% to 32.5%] of excess deaths between February 1 and September 23, 2020 were ascribed to causes of death other than Covid-19 itself. Excess deaths not assigned to Covid-19 were even higher than predicted by our model in counties with high income inequality, low homeownership, and high percentages of Black residents, showing a pattern related to socioeconomic disadvantage and structural racism. The standard deviation of mortality across counties increased by 9.5% as a result of excess deaths directly assigned to Covid-19 and an additional 5.3% as a result of excess deaths not assigned to Covid-19. Our work suggests that inequities in excess deaths attributable to Covid-19 may be even greater than revealed by data reporting deaths assigned to Covid-19 alone. ### Competing Interest Statement Dr. Stokes reported receiving grants from Ethicon Inc outside the submitted work. No other disclosures were reported. ### Funding Statement The Robert Wood Johnson Foundation supported the research reported in this publication. Elo was also supported by National Institute on Aging R01 AG060115 "Causes of Geographic Divergence in American Mortality Between 1990 and 2015: Health Behaviors, Health Care Access and Migration." ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: No consent was necessary. All the data used in the manuscript are publicly available. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data used in this manuscript are publicly available with the exception of the 2020 county population data, which are available through a special request to the U.S. Census Bureau. Further details about the data used in this analysis are provided at the linked GitHub repository.

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1 vote and 5 comments so far on Reddit

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