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

Quality death investigation is a critical piece of an effective public health system.1 When a person dies, a coroner, medical examiner, or health professional with knowledge of the decedent's medical conditions fills out the death certificate. Accurate cause-of death ascertainment has broad imp...

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Published in:	American journal of public health (1971) Vol. 111; no. S2; pp. S53 - S54
Main Authors:	Stokes, Andrew C., Lundberg, Dielle J., Bor, Jacob, Bibbins-Domingo, Kirsten
Format:	Journal Article
Language:	English
Published:	Washington American Public Health Association 01.07.2021
Subjects:	Certificates Certification Classifications Coronaviruses Coroners COVID-19 COVID-19 diagnostic tests Death Death & dying Death certificates Deaths Disease Drug overdose Ethnicity Fatalities Health care Health disparities Health services Inquests Medical conditions Medical personnel Medicine Mobilization Mortality Narcotics Opinions, Ideas, & Practice Pandemics Public health Racial inequality Racism Respiratory diseases Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Socioeconomic factors System effectiveness Systemic racism Viral diseases Vital statistics United States > US
ISSN:	0090-0036, 1541-0048, 1541-0048
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Abstract	Quality death investigation is a critical piece of an effective public health system.1 When a person dies, a coroner, medical examiner, or health professional with knowledge of the decedent's medical conditions fills out the death certificate. Accurate cause-of death ascertainment has broad implications for understanding the burden of disease throughout the United States. During the coronavirus disease 2019 (COVID-19) pandemic, vital statistics have had an important role in shaping the public health response, including recommendations for physical distancing and mask wearing, temporary lockdowns, and mobilization of health care systems.2 Racial and socioeconomic disparities in deaths attributed to COVID-19 have shown how structural racism contributed to vulnerability during the pandemic.3Although monitoring death certificates for reference to COVID-19 is a useful method for detecting the mortality associated with severe acute respiratory syndrome coronavirus 2 infection, it is likely to result in an undercount if COVID-19 is missing on death certificates in cases in which COVID-19 contributed to death.4-6 In fact, between 15% and 34% of excess deaths that occurred in 2020 during the COVID-19 pandemic were not directly assigned to COVID-19 on death certificates.7 These deaths likely include COVID-19 deaths not assigned to COVID-19 and indirect deaths related to social and economic consequences of the pandemic.
AbstractList	Quality death investigation is a critical piece of an effective public health system.1 When a person dies, a coroner, medical examiner, or health professional with knowledge of the decedent's medical conditions fills out the death certificate. Accurate cause-of death ascertainment has broad implications for understanding the burden of disease throughout the United States. During the coronavirus disease 2019 (COVID-19) pandemic, vital statistics have had an important role in shaping the public health response, including recommendations for physical distancing and mask wearing, temporary lockdowns, and mobilization of health care systems.2 Racial and socioeconomic disparities in deaths attributed to COVID-19 have shown how structural racism contributed to vulnerability during the pandemic.3Although monitoring death certificates for reference to COVID-19 is a useful method for detecting the mortality associated with severe acute respiratory syndrome coronavirus 2 infection, it is likely to result in an undercount if COVID-19 is missing on death certificates in cases in which COVID-19 contributed to death.4-6 In fact, between 15% and 34% of excess deaths that occurred in 2020 during the COVID-19 pandemic were not directly assigned to COVID-19 on death certificates.7 These deaths likely include COVID-19 deaths not assigned to COVID-19 and indirect deaths related to social and economic consequences of the pandemic.
Author	Bor, Jacob Stokes, Andrew C. Lundberg, Dielle J. Bibbins-Domingo, Kirsten
Author_xml	– sequence: 1 givenname: Andrew C. surname: Stokes fullname: Stokes, Andrew C. organization: Andrew C. Stokes and Dielle J. Lundberg are with the Department of Global Health, Boston University School of Public Health, Boston, MA. Jacob Bor is with the Department of Global Health and Department of Epidemiology, Boston University School of Public Health. Kirsten Bibbins-Domingo is with the Department of Epidemiology and Biostatistics and the Department of Medicine, University of California, San Francisco – sequence: 2 givenname: Dielle J. surname: Lundberg fullname: Lundberg, Dielle J. organization: Andrew C. Stokes and Dielle J. Lundberg are with the Department of Global Health, Boston University School of Public Health, Boston, MA. Jacob Bor is with the Department of Global Health and Department of Epidemiology, Boston University School of Public Health. Kirsten Bibbins-Domingo is with the Department of Epidemiology and Biostatistics and the Department of Medicine, University of California, San Francisco – sequence: 3 givenname: Jacob surname: Bor fullname: Bor, Jacob organization: Andrew C. Stokes and Dielle J. Lundberg are with the Department of Global Health, Boston University School of Public Health, Boston, MA. Jacob Bor is with the Department of Global Health and Department of Epidemiology, Boston University School of Public Health. Kirsten Bibbins-Domingo is with the Department of Epidemiology and Biostatistics and the Department of Medicine, University of California, San Francisco – sequence: 4 givenname: Kirsten surname: Bibbins-Domingo fullname: Bibbins-Domingo, Kirsten organization: Andrew C. Stokes and Dielle J. Lundberg are with the Department of Global Health, Boston University School of Public Health, Boston, MA. Jacob Bor is with the Department of Global Health and Department of Epidemiology, Boston University School of Public Health. Kirsten Bibbins-Domingo is with the Department of Epidemiology and Biostatistics and the Department of Medicine, University of California, San Francisco
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Cites_doi	10.1001/jamainternmed.2020.3391 10.1177/0033354917736514 10.1038/s41562-020-00977-7 10.1097/PHH.0000000000001263 10.1177/0033354918774330 10.15585/mmwr.mm6942e2 10.1001/jama.2020.9536 10.1001/jama.2021.5199 10.1371/journal.pmed.1003571 10.1073/pnas.2019378118
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SubjectTerms	Certificates Certification Classifications Coronaviruses Coroners COVID-19 COVID-19 diagnostic tests Death Death & dying Death certificates Deaths Disease Drug overdose Ethnicity Fatalities Health care Health disparities Health services Inquests Medical conditions Medical personnel Medicine Mobilization Mortality Narcotics Opinions, Ideas, & Practice Pandemics Public health Racial inequality Racism Respiratory diseases Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Socioeconomic factors System effectiveness Systemic racism Viral diseases Vital statistics
Title	Excess Deaths During the COVID-19 Pandemic: Implications for US Death Investigation Systems
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