Post by Nadica (She/Her) on Aug 9, 2024 1:01:54 GMT
Excess natural-cause mortality in US counties and its association with reported COVID-19 deaths - Published Feb 1, 2024
Significance
Official COVID-19 mortality statistics have not fully captured deaths attributable to SARS-CoV-2 infection in the United States. While some excess deaths were likely related to pandemic health care interruptions and socioeconomic disruptions, temporal correlations between reported COVID-19 deaths and excess deaths reported to non-COVID-19 natural causes suggest that many of those excess deaths were unrecognized COVID-19 deaths. Efforts to target resources during public health emergencies should consider geographic variation in the quality of mortality surveillance data. Incomplete or delayed cause-of-death reporting may obscure impacts in some areas, leading to ineffective and inequitable responses and evaluations of the pandemic’s effects. To address this, future pandemic preparedness and response efforts should include activities to strengthen the death investigation system.
Abstract
In the United States, estimates of excess deaths attributable to the COVID-19 pandemic have consistently surpassed reported COVID-19 death counts. Excess deaths reported to non-COVID-19 natural causes may represent unrecognized COVID-19 deaths, deaths caused by pandemic health care interruptions, and/or deaths from the pandemic’s socioeconomic impacts. The geographic and temporal distribution of these deaths may help to evaluate which explanation is most plausible. We developed a Bayesian hierarchical model to produce monthly estimates of excess natural-cause mortality for US counties over the first 30 mo of the pandemic. From March 2020 through August 2022, 1,194,610 excess natural-cause deaths occurred nationally [90% PI (Posterior Interval): 1,046,000 to 1,340,204]. A total of 162,886 of these excess natural-cause deaths (90% PI: 14,276 to 308,480) were not reported to COVID-19. Overall, 15.8 excess deaths were reported to non-COVID-19 natural causes for every 100 reported COVID-19 deaths. This number was greater in nonmetropolitan counties (36.0 deaths), the West (Rocky Mountain states: 31.6 deaths; Pacific states: 25.5 deaths), and the South (East South Central states: 26.0 deaths; South Atlantic states: 25.0 deaths; West South Central states: 24.2 deaths). In contrast, reported COVID-19 death counts surpassed estimates of excess natural-cause deaths in metropolitan counties in the New England and Middle Atlantic states. Increases in reported COVID-19 deaths correlated temporally with increases in excess deaths reported to non-COVID-19 natural causes in the same and/or prior month. This suggests that many excess deaths reported to non-COVID-19 natural causes during the first 30 mo of the pandemic in the United States were unrecognized COVID-19 deaths.
Significance
Official COVID-19 mortality statistics have not fully captured deaths attributable to SARS-CoV-2 infection in the United States. While some excess deaths were likely related to pandemic health care interruptions and socioeconomic disruptions, temporal correlations between reported COVID-19 deaths and excess deaths reported to non-COVID-19 natural causes suggest that many of those excess deaths were unrecognized COVID-19 deaths. Efforts to target resources during public health emergencies should consider geographic variation in the quality of mortality surveillance data. Incomplete or delayed cause-of-death reporting may obscure impacts in some areas, leading to ineffective and inequitable responses and evaluations of the pandemic’s effects. To address this, future pandemic preparedness and response efforts should include activities to strengthen the death investigation system.
Abstract
In the United States, estimates of excess deaths attributable to the COVID-19 pandemic have consistently surpassed reported COVID-19 death counts. Excess deaths reported to non-COVID-19 natural causes may represent unrecognized COVID-19 deaths, deaths caused by pandemic health care interruptions, and/or deaths from the pandemic’s socioeconomic impacts. The geographic and temporal distribution of these deaths may help to evaluate which explanation is most plausible. We developed a Bayesian hierarchical model to produce monthly estimates of excess natural-cause mortality for US counties over the first 30 mo of the pandemic. From March 2020 through August 2022, 1,194,610 excess natural-cause deaths occurred nationally [90% PI (Posterior Interval): 1,046,000 to 1,340,204]. A total of 162,886 of these excess natural-cause deaths (90% PI: 14,276 to 308,480) were not reported to COVID-19. Overall, 15.8 excess deaths were reported to non-COVID-19 natural causes for every 100 reported COVID-19 deaths. This number was greater in nonmetropolitan counties (36.0 deaths), the West (Rocky Mountain states: 31.6 deaths; Pacific states: 25.5 deaths), and the South (East South Central states: 26.0 deaths; South Atlantic states: 25.0 deaths; West South Central states: 24.2 deaths). In contrast, reported COVID-19 death counts surpassed estimates of excess natural-cause deaths in metropolitan counties in the New England and Middle Atlantic states. Increases in reported COVID-19 deaths correlated temporally with increases in excess deaths reported to non-COVID-19 natural causes in the same and/or prior month. This suggests that many excess deaths reported to non-COVID-19 natural causes during the first 30 mo of the pandemic in the United States were unrecognized COVID-19 deaths.