Excess mortality and potential undercounting of COVID-19 deaths by demographic group in Ohio

  1. Troy Quast
  2. Ross Andel

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Abstract

Background

There are significant gaps in our understanding of the mortality effects of COVID-19 due to evolving diagnosis criteria, shortages of testing supplies, and challenges faced by physicians in treating patients in crisis environments. Accurate information on the number of deaths caused by COVID-19 is vital for policy makers and health care providers.

Methods

We performed a retrospective study of weekly data for Ohio. To estimate expected mortality in 2020 we employed data from 2010 through 2019, adjusted for secular trends and seasonality. We estimated excess mortality as the number of observed deaths less the number of expected deaths. We conducted the analysis for the entire population and by age, gender, and county.

Results

We estimated 2,088 (95% CI 1,119-3,119) excess deaths due to natural causes in Ohio from March 15, 2020 through June 6, 2020. While the largest number excess of deaths was observed in the 80+ age group, our estimate of 366 (95% CI 110-655) excess deaths for those between 20 and 49 years of age substantially exceeds the reported number of COVID-19 deaths of 66.

Conclusions

Our methodology addressed some of the challenges of estimating the number of deaths caused by COVID-19. Our finding of excess deaths being considerably greater than the reported number of COVID-19 deaths for those aged 20 to 49 years old suggests that current tracking methods may not capture a significant number of COVID-19 deaths for this group. Further, increases in the infection rates for this cohort may have a greater mortality impact than anticipated.

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  1. Version published to 10.1101/2020.06.28.20141655v2 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2020.06.28.20141655: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. Our analysis was limited to one, albeit relatively large, U.S. state. There has been significant variation in the effects of COVID-19 across and within countries, so our findings do not necessarily apply universally. Our data were limited to the first several months of the outbreak and thus our results may not pertain to later stages. The methodology we employ does not definitively identify excess deaths as being due to COVID-19. Stressful events such as COVID-19 can lead to negative health outcomes such as increased incidence of cardiovascular events,20 poor medication adherence,21 and hypertension.22 Potential increases in mortality due to these types of effects would have been included in our estimates of excess deaths. Our mortality data were imperfect in that the 2019 and 2020 data were provisional and not finalized. The mortality data were based on state and county of residence at the time of death, rather than the location of occurrence. This choice was made to align the data with the reported number of COVID-19 deaths, but insight could be gained by exploring potential differences from basing the data on where the death occurred. As noted in the Supplementary Appendix, the date of death had to be approximated for ten of the 2,564 deaths in the reported COVID-19 deaths. The approach we employed indicated important differences in the effects of COVID-19 across demographic groups and identified potential shortcomings in published data. ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.06.28.20141655v1 on medRxiv