COVID-19 and excess mortality in the United States: A county-level analysis

Coronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the COVID-19 pandemic. Several prior studies have calculated excess deaths in the United States but were limited to the national or state level, precluding...

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Veröffentlicht in:PLoS medicine Jg. 18; H. 5; S. e1003571
Hauptverfasser: Stokes, Andrew C., Lundberg, Dielle J., Elo, Irma T., Hempstead, Katherine, Bor, Jacob, Preston, Samuel H.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Public Library of Science 20.05.2021
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ISSN:1549-1676, 1549-1277, 1549-1676
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Abstract Coronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the COVID-19 pandemic. Several prior studies have calculated excess deaths in the United States but were limited to the national or state level, precluding an examination of area-level variation in excess mortality and excess deaths not assigned to COVID-19. In this study, we take advantage of county-level variation in COVID-19 mortality to estimate excess deaths associated with the pandemic and examine how the extent of excess mortality not assigned to COVID-19 varies across subsets of counties defined by sociodemographic and health characteristics. In this ecological, cross-sectional study, we made use of provisional National Center for Health Statistics (NCHS) data on direct COVID-19 and all-cause mortality occurring in US counties from January 1 to December 31, 2020 and reported before March 12, 2021. We used data with a 10-week time lag between the final day that deaths occurred and the last day that deaths could be reported to improve the completeness of data. Our sample included 2,096 counties with 20 or more COVID-19 deaths. The total number of residents living in these counties was 319.1 million. On average, the counties were 18.7% Hispanic, 12.7% non-Hispanic Black, and 59.6% non-Hispanic White. A total of 15.9% of the population was older than 65 years. We first modeled the relationship between 2020 all-cause mortality and COVID-19 mortality across all counties and then produced fully stratified models to explore differences in this relationship among strata of sociodemographic and health factors. Overall, we found that for every 100 deaths assigned to COVID-19, 120 all-cause deaths occurred (95% CI, 116 to 124), implying that 17% (95% CI, 14% to 19%) of excess deaths were ascribed to causes of death other than COVID-19 itself. Our stratified models revealed that the percentage of excess deaths not assigned to COVID-19 was substantially higher among counties with lower median household incomes and less formal education, counties with poorer health and more diabetes, and counties in the South and West. Counties with more non-Hispanic Black residents, who were already at high risk of COVID-19 death based on direct counts, also reported higher percentages of excess deaths not assigned to COVID-19. Study limitations include the use of provisional data that may be incomplete and the lack of disaggregated data on county-level mortality by age, sex, race/ethnicity, and sociodemographic and health characteristics. In this study, we found that direct COVID-19 death counts in the US in 2020 substantially underestimated total excess mortality attributable to COVID-19. Racial and socioeconomic inequities in COVID-19 mortality also increased when excess deaths not assigned to COVID-19 were considered. Our results highlight the importance of considering health equity in the policy response to the pandemic.
AbstractList Coronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the COVID-19 pandemic. Several prior studies have calculated excess deaths in the United States but were limited to the national or state level, precluding an examination of area-level variation in excess mortality and excess deaths not assigned to COVID-19. In this study, we take advantage of county-level variation in COVID-19 mortality to estimate excess deaths associated with the pandemic and examine how the extent of excess mortality not assigned to COVID-19 varies across subsets of counties defined by sociodemographic and health characteristics. In this ecological, cross-sectional study, we made use of provisional National Center for Health Statistics (NCHS) data on direct COVID-19 and all-cause mortality occurring in US counties from January 1 to December 31, 2020 and reported before March 12, 2021. We used data with a 10-week time lag between the final day that deaths occurred and the last day that deaths could be reported to improve the completeness of data. Our sample included 2,096 counties with 20 or more COVID-19 deaths. The total number of residents living in these counties was 319.1 million. On average, the counties were 18.7% Hispanic, 12.7% non-Hispanic Black, and 59.6% non-Hispanic White. A total of 15.9% of the population was older than 65 years. We first modeled the relationship between 2020 all-cause mortality and COVID-19 mortality across all counties and then produced fully stratified models to explore differences in this relationship among strata of sociodemographic and health factors. Overall, we found that for every 100 deaths assigned to COVID-19, 120 all-cause deaths occurred (95% CI, 116 to 124), implying that 17% (95% CI, 14% to 19%) of excess deaths were ascribed to causes of death other than COVID-19 itself. Our stratified models revealed that the percentage of excess deaths not assigned to COVID-19 was substantially higher among counties with lower median household incomes and less formal education, counties with poorer health and more diabetes, and counties in the South and West. Counties with more non-Hispanic Black residents, who were already at high risk of COVID-19 death based on direct counts, also reported higher percentages of excess deaths not assigned to COVID-19. Study limitations include the use of provisional data that may be incomplete and the lack of disaggregated data on county-level mortality by age, sex, race/ethnicity, and sociodemographic and health characteristics. In this study, we found that direct COVID-19 death counts in the US in 2020 substantially underestimated total excess mortality attributable to COVID-19. Racial and socioeconomic inequities in COVID-19 mortality also increased when excess deaths not assigned to COVID-19 were considered. Our results highlight the importance of considering health equity in the policy response to the pandemic.
[...]COVID-19 death counts do not take into account the indirect consequences of the COVID-19 pandemic on mortality levels [10,11]. [...]the pandemic may reduce mortality as a result of reductions in travel and associated motor vehicle mortality, lower air pollution levels, or the possible benefits of COVID-19 mitigation efforts (i.e., mask wearing and physical distancing) on reducing influenza spread [18,19]. [...]the COVID-19 pandemic may reduce mortality from certain other causes of death because of frailty selection; those who die from COVID-19 may have been unusually frail and vulnerable to death from other diseases. [...]the rate of death from those diseases may decline and offset some of the increase in all-cause mortality attributable to COVID-19 deaths alone.
[...]COVID-19 death counts do not take into account the indirect consequences of the COVID-19 pandemic on mortality levels [10,11]. [...]the pandemic may reduce mortality as a result of reductions in travel and associated motor vehicle mortality, lower air pollution levels, or the possible benefits of COVID-19 mitigation efforts (i.e., mask wearing and physical distancing) on reducing influenza spread [18,19]. [...]the COVID-19 pandemic may reduce mortality from certain other causes of death because of frailty selection; those who die from COVID-19 may have been unusually frail and vulnerable to death from other diseases. [...]the rate of death from those diseases may decline and offset some of the increase in all-cause mortality attributable to COVID-19 deaths alone.
Coronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the COVID-19 pandemic. Several prior studies have calculated excess deaths in the United States but were limited to the national or state level, precluding an examination of area-level variation in excess mortality and excess deaths not assigned to COVID-19. In this study, we take advantage of county-level variation in COVID-19 mortality to estimate excess deaths associated with the pandemic and examine how the extent of excess mortality not assigned to COVID-19 varies across subsets of counties defined by sociodemographic and health characteristics.BACKGROUNDCoronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the COVID-19 pandemic. Several prior studies have calculated excess deaths in the United States but were limited to the national or state level, precluding an examination of area-level variation in excess mortality and excess deaths not assigned to COVID-19. In this study, we take advantage of county-level variation in COVID-19 mortality to estimate excess deaths associated with the pandemic and examine how the extent of excess mortality not assigned to COVID-19 varies across subsets of counties defined by sociodemographic and health characteristics.In this ecological, cross-sectional study, we made use of provisional National Center for Health Statistics (NCHS) data on direct COVID-19 and all-cause mortality occurring in US counties from January 1 to December 31, 2020 and reported before March 12, 2021. We used data with a 10-week time lag between the final day that deaths occurred and the last day that deaths could be reported to improve the completeness of data. Our sample included 2,096 counties with 20 or more COVID-19 deaths. The total number of residents living in these counties was 319.1 million. On average, the counties were 18.7% Hispanic, 12.7% non-Hispanic Black, and 59.6% non-Hispanic White. A total of 15.9% of the population was older than 65 years. We first modeled the relationship between 2020 all-cause mortality and COVID-19 mortality across all counties and then produced fully stratified models to explore differences in this relationship among strata of sociodemographic and health factors. Overall, we found that for every 100 deaths assigned to COVID-19, 120 all-cause deaths occurred (95% CI, 116 to 124), implying that 17% (95% CI, 14% to 19%) of excess deaths were ascribed to causes of death other than COVID-19 itself. Our stratified models revealed that the percentage of excess deaths not assigned to COVID-19 was substantially higher among counties with lower median household incomes and less formal education, counties with poorer health and more diabetes, and counties in the South and West. Counties with more non-Hispanic Black residents, who were already at high risk of COVID-19 death based on direct counts, also reported higher percentages of excess deaths not assigned to COVID-19. Study limitations include the use of provisional data that may be incomplete and the lack of disaggregated data on county-level mortality by age, sex, race/ethnicity, and sociodemographic and health characteristics.METHODS AND FINDINGSIn this ecological, cross-sectional study, we made use of provisional National Center for Health Statistics (NCHS) data on direct COVID-19 and all-cause mortality occurring in US counties from January 1 to December 31, 2020 and reported before March 12, 2021. We used data with a 10-week time lag between the final day that deaths occurred and the last day that deaths could be reported to improve the completeness of data. Our sample included 2,096 counties with 20 or more COVID-19 deaths. The total number of residents living in these counties was 319.1 million. On average, the counties were 18.7% Hispanic, 12.7% non-Hispanic Black, and 59.6% non-Hispanic White. A total of 15.9% of the population was older than 65 years. We first modeled the relationship between 2020 all-cause mortality and COVID-19 mortality across all counties and then produced fully stratified models to explore differences in this relationship among strata of sociodemographic and health factors. Overall, we found that for every 100 deaths assigned to COVID-19, 120 all-cause deaths occurred (95% CI, 116 to 124), implying that 17% (95% CI, 14% to 19%) of excess deaths were ascribed to causes of death other than COVID-19 itself. Our stratified models revealed that the percentage of excess deaths not assigned to COVID-19 was substantially higher among counties with lower median household incomes and less formal education, counties with poorer health and more diabetes, and counties in the South and West. Counties with more non-Hispanic Black residents, who were already at high risk of COVID-19 death based on direct counts, also reported higher percentages of excess deaths not assigned to COVID-19. Study limitations include the use of provisional data that may be incomplete and the lack of disaggregated data on county-level mortality by age, sex, race/ethnicity, and sociodemographic and health characteristics.In this study, we found that direct COVID-19 death counts in the US in 2020 substantially underestimated total excess mortality attributable to COVID-19. Racial and socioeconomic inequities in COVID-19 mortality also increased when excess deaths not assigned to COVID-19 were considered. Our results highlight the importance of considering health equity in the policy response to the pandemic.CONCLUSIONSIn this study, we found that direct COVID-19 death counts in the US in 2020 substantially underestimated total excess mortality attributable to COVID-19. Racial and socioeconomic inequities in COVID-19 mortality also increased when excess deaths not assigned to COVID-19 were considered. Our results highlight the importance of considering health equity in the policy response to the pandemic.
Background Coronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the COVID-19 pandemic. Several prior studies have calculated excess deaths in the United States but were limited to the national or state level, precluding an examination of area-level variation in excess mortality and excess deaths not assigned to COVID-19. In this study, we take advantage of county-level variation in COVID-19 mortality to estimate excess deaths associated with the pandemic and examine how the extent of excess mortality not assigned to COVID-19 varies across subsets of counties defined by sociodemographic and health characteristics. Methods and findings In this ecological, cross-sectional study, we made use of provisional National Center for Health Statistics (NCHS) data on direct COVID-19 and all-cause mortality occurring in US counties from January 1 to December 31, 2020 and reported before March 12, 2021. We used data with a 10-week time lag between the final day that deaths occurred and the last day that deaths could be reported to improve the completeness of data. Our sample included 2,096 counties with 20 or more COVID-19 deaths. The total number of residents living in these counties was 319.1 million. On average, the counties were 18.7% Hispanic, 12.7% non-Hispanic Black, and 59.6% non-Hispanic White. A total of 15.9% of the population was older than 65 years. We first modeled the relationship between 2020 all-cause mortality and COVID-19 mortality across all counties and then produced fully stratified models to explore differences in this relationship among strata of sociodemographic and health factors. Overall, we found that for every 100 deaths assigned to COVID-19, 120 all-cause deaths occurred (95% CI, 116 to 124), implying that 17% (95% CI, 14% to 19%) of excess deaths were ascribed to causes of death other than COVID-19 itself. Our stratified models revealed that the percentage of excess deaths not assigned to COVID-19 was substantially higher among counties with lower median household incomes and less formal education, counties with poorer health and more diabetes, and counties in the South and West. Counties with more non-Hispanic Black residents, who were already at high risk of COVID-19 death based on direct counts, also reported higher percentages of excess deaths not assigned to COVID-19. Study limitations include the use of provisional data that may be incomplete and the lack of disaggregated data on county-level mortality by age, sex, race/ethnicity, and sociodemographic and health characteristics. Conclusions In this study, we found that direct COVID-19 death counts in the US in 2020 substantially underestimated total excess mortality attributable to COVID-19. Racial and socioeconomic inequities in COVID-19 mortality also increased when excess deaths not assigned to COVID-19 were considered. Our results highlight the importance of considering health equity in the policy response to the pandemic.
BackgroundCoronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the COVID-19 pandemic. Several prior studies have calculated excess deaths in the United States but were limited to the national or state level, precluding an examination of area-level variation in excess mortality and excess deaths not assigned to COVID-19. In this study, we take advantage of county-level variation in COVID-19 mortality to estimate excess deaths associated with the pandemic and examine how the extent of excess mortality not assigned to COVID-19 varies across subsets of counties defined by sociodemographic and health characteristics.Methods and findingsIn this ecological, cross-sectional study, we made use of provisional National Center for Health Statistics (NCHS) data on direct COVID-19 and all-cause mortality occurring in US counties from January 1 to December 31, 2020 and reported before March 12, 2021. We used data with a 10-week time lag between the final day that deaths occurred and the last day that deaths could be reported to improve the completeness of data. Our sample included 2,096 counties with 20 or more COVID-19 deaths. The total number of residents living in these counties was 319.1 million. On average, the counties were 18.7% Hispanic, 12.7% non-Hispanic Black, and 59.6% non-Hispanic White. A total of 15.9% of the population was older than 65 years. We first modeled the relationship between 2020 all-cause mortality and COVID-19 mortality across all counties and then produced fully stratified models to explore differences in this relationship among strata of sociodemographic and health factors. Overall, we found that for every 100 deaths assigned to COVID-19, 120 all-cause deaths occurred (95% CI, 116 to 124), implying that 17% (95% CI, 14% to 19%) of excess deaths were ascribed to causes of death other than COVID-19 itself. Our stratified models revealed that the percentage of excess deaths not assigned to COVID-19 was substantially higher among counties with lower median household incomes and less formal education, counties with poorer health and more diabetes, and counties in the South and West. Counties with more non-Hispanic Black residents, who were already at high risk of COVID-19 death based on direct counts, also reported higher percentages of excess deaths not assigned to COVID-19. Study limitations include the use of provisional data that may be incomplete and the lack of disaggregated data on county-level mortality by age, sex, race/ethnicity, and sociodemographic and health characteristics.ConclusionsIn this study, we found that direct COVID-19 death counts in the US in 2020 substantially underestimated total excess mortality attributable to COVID-19. Racial and socioeconomic inequities in COVID-19 mortality also increased when excess deaths not assigned to COVID-19 were considered. Our results highlight the importance of considering health equity in the policy response to the pandemic.
Andrew Stokes and co-workers report a county-level analysis of excess deaths owing to COVID-19 in the United States.
Coronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the COVID-19 pandemic. Several prior studies have calculated excess deaths in the United States but were limited to the national or state level, precluding an examination of area-level variation in excess mortality and excess deaths not assigned to COVID-19. In this study, we take advantage of county-level variation in COVID-19 mortality to estimate excess deaths associated with the pandemic and examine how the extent of excess mortality not assigned to COVID-19 varies across subsets of counties defined by sociodemographic and health characteristics. In this ecological, cross-sectional study, we made use of provisional National Center for Health Statistics (NCHS) data on direct COVID-19 and all-cause mortality occurring in US counties from January 1 to December 31, 2020 and reported before March 12, 2021. We used data with a 10-week time lag between the final day that deaths occurred and the last day that deaths could be reported to improve the completeness of data. Our sample included 2,096 counties with 20 or more COVID-19 deaths. The total number of residents living in these counties was 319.1 million. On average, the counties were 18.7% Hispanic, 12.7% non-Hispanic Black, and 59.6% non-Hispanic White. A total of 15.9% of the population was older than 65 years. We first modeled the relationship between 2020 all-cause mortality and COVID-19 mortality across all counties and then produced fully stratified models to explore differences in this relationship among strata of sociodemographic and health factors. Overall, we found that for every 100 deaths assigned to COVID-19, 120 all-cause deaths occurred (95% CI, 116 to 124), implying that 17% (95% CI, 14% to 19%) of excess deaths were ascribed to causes of death other than COVID-19 itself. Our stratified models revealed that the percentage of excess deaths not assigned to COVID-19 was substantially higher among counties with lower median household incomes and less formal education, counties with poorer health and more diabetes, and counties in the South and West. Counties with more non-Hispanic Black residents, who were already at high risk of COVID-19 death based on direct counts, also reported higher percentages of excess deaths not assigned to COVID-19. Study limitations include the use of provisional data that may be incomplete and the lack of disaggregated data on county-level mortality by age, sex, race/ethnicity, and sociodemographic and health characteristics. In this study, we found that direct COVID-19 death counts in the US in 2020 substantially underestimated total excess mortality attributable to COVID-19. Racial and socioeconomic inequities in COVID-19 mortality also increased when excess deaths not assigned to COVID-19 were considered. Our results highlight the importance of considering health equity in the policy response to the pandemic.
Audience Academic
Author Elo, Irma T.
Bor, Jacob
Preston, Samuel H.
Stokes, Andrew C.
Lundberg, Dielle J.
Hempstead, Katherine
AuthorAffiliation 4 Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
2 Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
1 Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
PLOS Medicine Editorial Board, UNITED STATES
3 Robert Wood Johnson Foundation, Princeton, New Jersey, United States of America
AuthorAffiliation_xml – name: 4 Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
– name: 1 Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
– name: 2 Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
– name: 3 Robert Wood Johnson Foundation, Princeton, New Jersey, United States of America
– name: PLOS Medicine Editorial Board, UNITED STATES
Author_xml – sequence: 1
  givenname: Andrew C.
  orcidid: 0000-0002-8502-3636
  surname: Stokes
  fullname: Stokes, Andrew C.
– sequence: 2
  givenname: Dielle J.
  orcidid: 0000-0003-1494-4443
  surname: Lundberg
  fullname: Lundberg, Dielle J.
– sequence: 3
  givenname: Irma T.
  surname: Elo
  fullname: Elo, Irma T.
– sequence: 4
  givenname: Katherine
  surname: Hempstead
  fullname: Hempstead, Katherine
– sequence: 5
  givenname: Jacob
  orcidid: 0000-0002-5112-8536
  surname: Bor
  fullname: Bor, Jacob
– sequence: 6
  givenname: Samuel H.
  surname: Preston
  fullname: Preston, Samuel H.
BackLink https://www.ncbi.nlm.nih.gov/pubmed/34014945$$D View this record in MEDLINE/PubMed
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Cites_doi 10.1371/journal.pone.0241327
10.1016/j.cjca.2020.05.018
10.1016/S0140-6736(20)30854-0
10.1016/j.dsx.2020.06.008
10.1001/jama.2020.19545
10.15585/mmwr.mm6923e1
10.1016/j.paid.2020.110233
10.1073/pnas.2006706117
10.1016/S0140-6736(20)31189-2
10.3390/nu12061648
10.1371/journal.pone.0242044
10.1037/tra0000871
10.1093/jamia/ocaa156
10.2307/2335377
10.1056/NEJMsa2011686
10.2139/ssrn.3569098
10.1073/pnas.2019378118
10.1097/PHH.0000000000001263
10.1001/jama.2020.20717
10.1016/S0140-6736(20)30933-8
10.1161/CIRCULATIONAHA.105.595777
10.1016/j.jacc.2020.03.031
10.1371/journal.pmed.1003402
10.1001/jama.2020.9972
ContentType Journal Article
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I have read the journal’s policy and the authors of this manuscript have the following competing interests: ACS reported receiving grants from Ethicon Inc. and Swiss Re outside the submitted work. No other disclosures were reported.
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References PA Buescher (pmed.1003571.ref033) 1997
GB Cunningham (pmed.1003571.ref029) 2020; 15
JT Mueller (pmed.1003571.ref041) 2021; 118
DM Weinberger (pmed.1003571.ref021) 2020
M Spencer (pmed.1003571.ref031) 2016
CJL Murray (pmed.1003571.ref044) 2006; 113
M Painter (pmed.1003571.ref045) 2020
JS Faust (pmed.1003571.ref047) 2020
SH Preston (pmed.1003571.ref035) 2001
pmed.1003571.ref050
MJ Dubey (pmed.1003571.ref014) 2020; 14
Office of National Statistics (pmed.1003571.ref034); 2020
DA Leon (pmed.1003571.ref005) 2020; 395
A Baum (pmed.1003571.ref010) 2020; 324
M Bassett (pmed.1003571.ref051) 2020
A Mendy (pmed.1003571.ref052) 2020
CIA Oronce (pmed.1003571.ref027); 2020
MS Shiels (pmed.1003571.ref040) 2020
pmed.1003571.ref020
V Kontis (pmed.1003571.ref023) 2020
EJ Raker (pmed.1003571.ref012) 2020; 117
A Bilinski (pmed.1003571.ref048) 2020; 324
RB Davies (pmed.1003571.ref054) 1975; 62
NM Summers-Gabr (pmed.1003571.ref042) 2020; 12
pmed.1003571.ref039
JT Chen (pmed.1003571.ref049); 2020
KA Hirko (pmed.1003571.ref043) 2020; 27
pmed.1003571.ref032
JT Chen (pmed.1003571.ref024) 2021; 27
M Boukhris (pmed.1003571.ref008) 2020; 36
A Banerjee (pmed.1003571.ref004) 2020; 395
JR Gill (pmed.1003571.ref006) 2020
MT Bassett (pmed.1003571.ref026) 2020; 17
JR Goldstein (pmed.1003571.ref036); 2020
National Center for Health Statistics (pmed.1003571.ref037) 2020
E Driggin (pmed.1003571.ref009) 2020; 75
F Shilling (pmed.1003571.ref018) 2020
H Prime (pmed.1003571.ref017); 2020
E Dong (pmed.1003571.ref003) 2020; 3099
FD Mann (pmed.1003571.ref016) 2020; 167
KP Hartnett (pmed.1003571.ref011) 2020; 69
J Zelner (pmed.1003571.ref025) 2020
Y-H Chen (pmed.1003571.ref030) 2020
AS Fauci (pmed.1003571.ref001) 2020
K Ahmad (pmed.1003571.ref028) 2020
SH Woolf (pmed.1003571.ref038) 2020; 324
S Kung (pmed.1003571.ref019) 2020
R Del Pinto (pmed.1003571.ref007) 2020
L. Sher (pmed.1003571.ref013) 2020
C Adolph (pmed.1003571.ref046); 2020
SH Woolf (pmed.1003571.ref022) 2020
EG Price-Haywood (pmed.1003571.ref053) 2020; 382
MJ Cummings (pmed.1003571.ref002) 2020; 395
JA Wolfson (pmed.1003571.ref015) 2020; 12
References_xml – year: 2020
  ident: pmed.1003571.ref018
  article-title: Special Report (Update): Impact of COVID19 Mitigation on Numbers and Costs of California Traffic Crashes
– start-page: e0241327
  year: 2020
  ident: pmed.1003571.ref028
  article-title: Association of poor housing conditions with COVID-19 incidence and mortality across US counties
  publication-title: PLoS ONE
  doi: 10.1371/journal.pone.0241327
– year: 2020
  ident: pmed.1003571.ref047
  article-title: All-Cause Excess Mortality and COVID-19–Related Mortality Among US Adults Aged 25–44 Years, March-July 2020
  publication-title: JAMA
– volume: 2020
  start-page: 2020
  ident: pmed.1003571.ref046
  article-title: Pandemic Politics: Timing State-Level Social Distancing Responses to COVID-19
  publication-title: J Health Polit Policy Law
– year: 2020
  ident: pmed.1003571.ref001
  article-title: Covid-19—Navigating the Uncharted
  publication-title: N Engl J Med
– volume: 2020
  start-page: 631
  ident: pmed.1003571.ref017
  article-title: Risk and resilience in family well-being during the COVID-19 pandemic
  publication-title: Am Psychol
– volume: 3099
  start-page: 19
  year: 2020
  ident: pmed.1003571.ref003
  article-title: An interactive web-based dashboard to track COVID-19 in real time
  publication-title: Lancet Infect Dis.
– year: 2016
  ident: pmed.1003571.ref031
  article-title: Timeliness of Death Certificate Data for Mortality Surveillance and Provisional Estimates, Vital Statistics Rapid Release
  publication-title: Special Report
– volume: 36
  start-page: 1068
  year: 2020
  ident: pmed.1003571.ref008
  article-title: Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective
  publication-title: Can J Cardiol
  doi: 10.1016/j.cjca.2020.05.018
– volume: 395
  start-page: 1715
  year: 2020
  ident: pmed.1003571.ref004
  article-title: Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort study
  publication-title: Lancet
  doi: 10.1016/S0140-6736(20)30854-0
– ident: pmed.1003571.ref032
– year: 2020
  ident: pmed.1003571.ref037
  publication-title: Excess Deaths Associated with COVID-19
– volume: 14
  start-page: 817
  year: 2020
  ident: pmed.1003571.ref014
  article-title: COVID-19 and addiction
  publication-title: Diabetes Metab Syndr.
  doi: 10.1016/j.dsx.2020.06.008
– volume: 2020
  start-page: 1
  ident: pmed.1003571.ref034
  article-title: Coronavirus (COVID-19) related deaths by occupation
  publication-title: England and Wales: deaths registered up to and including 20 April 2020
– volume: 324
  start-page: 1562
  year: 2020
  ident: pmed.1003571.ref038
  article-title: Excess Deaths From COVID-19 and Other Causes, March-July 2020
  publication-title: JAMA
  doi: 10.1001/jama.2020.19545
– year: 2020
  ident: pmed.1003571.ref013
  article-title: The impact of the COVID-19 pandemic on suicide rates
  publication-title: QJM
– year: 2020
  ident: pmed.1003571.ref019
  article-title: Reduced mortality in New Zealand during the COVID-19 pandemic
  publication-title: Lancet
– volume: 69
  start-page: 699
  year: 2020
  ident: pmed.1003571.ref011
  article-title: Impact of the COVID-19 Pandemic on Emergency Department Visits—United States, January 1, 2019-May 30, 2020
  publication-title: MMWR Morb Mortal Wkly Rep
  doi: 10.15585/mmwr.mm6923e1
– year: 2020
  ident: pmed.1003571.ref052
  article-title: Factors Associated with Hospitalization and Disease Severity in a Racially and Ethnically Diverse Population of COVID-19 Patients
  publication-title: medRxiv
– volume: 167
  start-page: 110233
  year: 2020
  ident: pmed.1003571.ref016
  article-title: Personal economic anxiety in response to COVID-19
  publication-title: Personal Individ Differ.
  doi: 10.1016/j.paid.2020.110233
– volume: 2020
  start-page: 2020
  ident: pmed.1003571.ref036
  article-title: Improved measurement of racial/ethnic disparities in COVID-19 mortality in the United States
  publication-title: medRxiv
– volume: 117
  start-page: 12595
  year: 2020
  ident: pmed.1003571.ref012
  article-title: Lessons from Hurricane Katrina for predicting the indirect health consequences of the COVID-19 pandemic
  publication-title: Proc Natl Acad Sci U S A
  doi: 10.1073/pnas.2006706117
– year: 2020
  ident: pmed.1003571.ref023
  article-title: Age- and sex-specific total mortality impacts of the early weeks of the Covid-19 pandemic in England and Wales: Application of a Bayesian model ensemble to mortality statistics
  publication-title: medRxiv
– year: 2020
  ident: pmed.1003571.ref022
  article-title: Excess Deaths From COVID-19 and Other Causes, March-April 2020
  publication-title: JAMA
– volume: 395
  start-page: 1763
  year: 2020
  ident: pmed.1003571.ref002
  article-title: Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study
  publication-title: Lancet
  doi: 10.1016/S0140-6736(20)31189-2
– ident: pmed.1003571.ref039
– volume: 12
  year: 2020
  ident: pmed.1003571.ref015
  article-title: Food Insecurity and COVID-19: Disparities in Early Effects for US Adults
  publication-title: Nutrients.
  doi: 10.3390/nu12061648
– volume: 15
  start-page: e0242044
  year: 2020
  ident: pmed.1003571.ref029
  article-title: Race, explicit racial attitudes, implicit racial attitudes, and COVID-19 cases and deaths: An analysis of counties in the United States.
  publication-title: PLoS ONE.
  doi: 10.1371/journal.pone.0242044
– volume: 12
  start-page: S222
  year: 2020
  ident: pmed.1003571.ref042
  article-title: Rural-urban mental health disparities in the United States during COVID-19
  publication-title: Psychol Trauma.
  doi: 10.1037/tra0000871
– volume: 27
  start-page: 1816
  year: 2020
  ident: pmed.1003571.ref043
  article-title: Telehealth in response to the COVID-19 pandemic: Implications for rural health disparities
  publication-title: J Am Med Inform Assoc
  doi: 10.1093/jamia/ocaa156
– volume: 62
  start-page: 383
  year: 1975
  ident: pmed.1003571.ref054
  article-title: The Effect of Errors in the Independent Variables in Linear Regression
  publication-title: Biometrika
  doi: 10.2307/2335377
– volume: 382
  start-page: 2534
  year: 2020
  ident: pmed.1003571.ref053
  article-title: Hospitalization and Mortality among Black Patients and White Patients with Covid-19
  publication-title: N Engl J Med
  doi: 10.1056/NEJMsa2011686
– year: 2020
  ident: pmed.1003571.ref045
  article-title: Political beliefs affect compliance with covid-19 social distancing orders
  doi: 10.2139/ssrn.3569098
– year: 1997
  ident: pmed.1003571.ref033
  article-title: Problems with rates based on small numbers
  publication-title: State Center for Health Statistics
– year: 2020
  ident: pmed.1003571.ref006
  article-title: The Importance of Proper Death Certification During the COVID-19
  publication-title: Pandemic. JAMA
– ident: pmed.1003571.ref020
– volume: 118
  start-page: 2019378118
  year: 2021
  ident: pmed.1003571.ref041
  article-title: Impacts of the COVID-19 pandemic on rural America
  publication-title: Proc Natl Acad Sci U S A
  doi: 10.1073/pnas.2019378118
– year: 2020
  ident: pmed.1003571.ref025
  article-title: Racial disparities in COVID-19 mortality are driven by unequal infection risks
  publication-title: Clinical infectious diseases: an official publication of the Infectious Diseases Society of America
– volume: 27
  start-page: S43
  issue: Suppl 1
  year: 2021
  ident: pmed.1003571.ref024
  article-title: Revealing the Unequal Burden of COVID-19 by Income, Race/Ethnicity, and Household Crowding: US County Versus Zip Code Analyses
  publication-title: J Public Health Manag PractCOVID-19 and Public Health: Looking Back, Moving Forward
  doi: 10.1097/PHH.0000000000001263
– volume: 324
  start-page: 2100
  year: 2020
  ident: pmed.1003571.ref048
  article-title: COVID-19 and Excess All-Cause Mortality in the US and 18 Comparison Countries
  publication-title: JAMA
  doi: 10.1001/jama.2020.20717
– volume: 2020
  start-page: 19
  ident: pmed.1003571.ref049
  article-title: COVID-19 and the unequal surge in mortality rates in Massachusetts, by city/town and ZIP Code measures of poverty, household crowding, race/ethnicity,and racialized economic segregation
  publication-title: Harvard Center for Population and Development Studies Working Paper Series
– volume: 2020
  start-page: 2791
  ident: pmed.1003571.ref027
  article-title: Association Between State-Level Income Inequality and COVID-19 Cases and Mortality in the USA
  publication-title: J Gen Intern Med
– volume: 395
  start-page: e81
  year: 2020
  ident: pmed.1003571.ref005
  article-title: COVID-19: a need for real-time monitoring of weekly excess deaths
  publication-title: Lancet
  doi: 10.1016/S0140-6736(20)30933-8
– volume: 113
  start-page: 2071
  year: 2006
  ident: pmed.1003571.ref044
  article-title: Understanding the coronary heart disease versus total cardiovascular mortality paradox: a method to enhance the comparability of cardiovascular death statistics in the United States
  publication-title: Circulation
  doi: 10.1161/CIRCULATIONAHA.105.595777
– year: 2020
  ident: pmed.1003571.ref007
  article-title: Increased cardiovascular death rates in a COVID-19 low prevalence area
  publication-title: J Clin Hypertens (Greenwich)
– volume-title: Demography: Measuring and Modeling Population Processes
  year: 2001
  ident: pmed.1003571.ref035
– year: 2020
  ident: pmed.1003571.ref021
  article-title: Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020
  publication-title: JAMA Intern Med
– year: 2020
  ident: pmed.1003571.ref051
  article-title: Working Paper, The Unequal Toll of Covid-19 Mortality by Age in the United States: Quantifying Racial/Ethnic Disparities
– volume: 75
  start-page: 2352
  year: 2020
  ident: pmed.1003571.ref009
  article-title: Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic
  publication-title: J Am Coll Cardiol
  doi: 10.1016/j.jacc.2020.03.031
– volume: 17
  start-page: e1003402
  year: 2020
  ident: pmed.1003571.ref026
  article-title: Variation in racial/ethnic disparities in COVID-19 mortality by age in the United States: A cross-sectional study
  publication-title: PLoS Med
  doi: 10.1371/journal.pmed.1003402
– ident: pmed.1003571.ref050
– year: 2020
  ident: pmed.1003571.ref030
  article-title: Excess Mortality in California During the Coronavirus Disease 2019 Pandemic, March to August 2020
  publication-title: JAMA Intern Med
– volume: 324
  start-page: 96
  year: 2020
  ident: pmed.1003571.ref010
  article-title: Admissions to Veterans Affairs Hospitals for Emergency Conditions During the COVID-19 Pandemic
  publication-title: JAMA.
  doi: 10.1001/jama.2020.9972
– year: 2020
  ident: pmed.1003571.ref040
  article-title: Impact of Population Growth and Aging on Estimates of Excess U.S. Deaths During the COVID-19 Pandemic, March to August 2020
  publication-title: Ann Intern Med
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Snippet Coronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the COVID-19...
Background Coronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the...
[...]COVID-19 death counts do not take into account the indirect consequences of the COVID-19 pandemic on mortality levels [10,11]. [...]the pandemic may...
Andrew Stokes and co-workers report a county-level analysis of excess deaths owing to COVID-19 in the United States.
BackgroundCoronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the...
[...]COVID-19 death counts do not take into account the indirect consequences of the COVID-19 pandemic on mortality levels [10,11]. [...]the pandemic may...
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StartPage e1003571
SubjectTerms Air pollution
Biology and Life Sciences
Coronaviruses
COVID-19
COVID-19 diagnostic tests
Death
Demographic aspects
Disease transmission
Distribution
Estimates
Influenza
Medical supplies
Medicine and Health Sciences
Mortality
Motor vehicles
Outdoor air quality
Pandemics
People and Places
Pollution levels
Population
Risk factors
Severe acute respiratory syndrome coronavirus 2
Sociodemographics
United States
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Title COVID-19 and excess mortality in the United States: A county-level analysis
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http://dx.doi.org/10.1371/journal.pmed.1003571
Volume 18
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