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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Bibliographic Details
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
Online Access:Get full text
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Summary: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.
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All authors contributed equally to the drafting and editing of this article.
CONTRIBUTORS
ISSN:0090-0036
1541-0048
1541-0048
DOI:10.2105/AJPH.2021.306331