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

  1. Eugenio Paglino
  2. Dielle J. Lundberg
  3. Zhenwei Zhou
  4. Joe A. Wasserman
  5. Rafeya Raquib
  6. Anneliese N. Luck
  7. Katherine Hempstead
  8. Jacob Bor
  9. Samuel H. Preston
  10. Irma T. Elo
  11. Andrew C. Stokes

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Abstract

Excess mortality is the difference between expected and observed mortality in a given period and has emerged as a leading measure of the COVID-19 pandemic’s mortality impact. Spatially and temporally granular estimates of excess mortality are needed to understand which areas have been most impacted by the pandemic, evaluate exacerbating factors, and inform response efforts. We estimated all-cause excess mortality for the United States from March 2020 through February 2022 by county and month using a Bayesian hierarchical model trained on data from 2015 to 2019. An estimated 1,179,024 excess deaths occurred during the first 2 years of the pandemic (first: 634,830; second: 544,194). Overall, excess mortality decreased in large metropolitan counties but increased in nonmetropolitan counties. Despite the initial concentration of mortality in large metropolitan Northeastern counties, nonmetropolitan Southern counties had the highest cumulative relative excess mortality by July 2021. These results highlight the need for investments in rural health as the pandemic’s rural impact grows.

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  1. Version published to 10.1126/sciadv.adf9742
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    SciScore for 10.1101/2022.04.23.22274192: (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

    Software and Algorithms
    SentencesResources
    Programming code was developed using R, version 4.1.0 (R Project for Statistical Computing) and Python, version 3.7.13 (Python Software Foundation).
    R Project for Statistical
    suggested: None
    Python
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    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The study had several limitations. First, the study relied on publicly available data, which were subject to suppression of death counts fewer than 10 in a given county-month. We addressed this limitation using an imputation approach with annual data, however, our estimates remain uncertain in areas with small populations and few deaths. Second, some counties and states have experienced prolonged reporting delays of Covid-19 deaths, which could affect our estimates of the proportion of excess deaths assigned to Covid-19. Third, the estimates produced by this study identify more excess deaths than a prior analysis of county-level excess deaths during 2020 due to differences in methods and time horizons.(4, 35) We also found a lower percentage of excess deaths assigned to Covid-19 since we used underlying cause of death data rather than assessing whether Covid-19 appeared anywhere on the death certificate. Fourth, we were unable to distinguish between excess deaths from natural causes and excess deaths indirectly related to the pandemic. Future research should examine this distinction to clarify the extent to which unassigned excess deaths reported in this study represent under-reporting of Covid-19 deaths. Finally, our model does not account for differences in age structure between counties. Since the pandemic has affected older populations more significantly, some differences in mortality observed between counties may simply reflect differences in their age distribution. Thus...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

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

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2022.04.23.22274192 on medRxiv