Uncoupling of all-cause excess mortality from COVID-19 cases in a highly vaccinated state

Faust, Jeremy Samuel; Renton, Benjamin; Chen, Alexander; Du, Chengan; Liang, Chenxue; Li, Shuxia; Lin, Zhenqiu; Krumholz, Harlan M.

doi:10.1016/s1473-3099(22)00547-3

Cited by 18 publications

(14 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…27 Additionally, we corrected for the ongoing population changes (i.e., smaller increases than expected), owing to cumulative excess mortality observed during the pandemic, as described previously. 8,[14][15][16] The study has several limitations. First, while all-cause and COVID-19-specific mortality trends were highly aligned, we cannot definitively establish the cause of the excess deaths.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…We further adjusted (i.e., lowered) the population during the pandemic period to in proportion to the cumulative excess mortality recorded during the pandemic, so as to capture the smaller than expected population, owing to pandemic-associated all-cause excess mortality, as described previously. [14][15][16]…”

Section: Data Sourcesmentioning

confidence: 99%

See 2 more Smart Citations

Two years of COVID-19: Excess mortality by age, region, gender, and race/ethnicity in the United States during the COVID-19 pandemic, March 1, 2020, through February 28, 2022

Faust

Renton

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Introduction: Excess mortality does not depend on labeling the cause of death and is an accurate representation of the pandemic population-level effects. A comprehensive evaluation of all-cause excess mortality in the United States during the first two years of the Covid-19 pandemic, stratified by age, sex, region, and race/ethnicity can provide insight into the extent and variation in harm. Methods: With Centers for Disease Control and Prevention (CDC)/National Center for Health Statistics (NCHS) data from 2014-2022, we use seasonal autoregressive integrated moving averages (sARIMA) to estimate excess mortality during the pandemic, defined as the difference between the number of observed and expected deaths. We continuously correct the number of monthly expected deaths to reflect the decreased population owing to cumulative pandemic-associated excess deaths recorded. We calculate excess mortality for the total US population, and by age, sex, US census division, and race/ethnicity. Results: From March 1, 2020, through February 28, 2022, there were 1.17 million excess deaths in the United States. Overall, mortality was 20% higher than expected during the study period. Of the excess deaths, 799,477 (68%) were among residents aged 65 and older. The largest relative increase in all-cause mortality was 27% among adults ages 18-49 years. Males comprised most of the excess mortality (57%), though this predominance declined with increasing age. A higher relative increase in mortality occurred among Hispanic and non-Hispanic Black persons. Excess mortality differed by region; the highest rates were in the South, including in the population ages ≥65 years. Excess mortality rose and fell contemporaneously with Covid-19 waves. Conclusion: In the first two years of the pandemic, the US experienced 1.17 million excess deaths, with greater relative increases in all-cause mortality among men, in Black and Hispanic people, and in the South.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Two years of COVID-19: Excess mortality by age, region, gender, and race/ethnicity in the United States during the COVID-19 pandemic, March 1, 2020, through February 28, 2022

Faust

Renton

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Vaccine uptake in Massachusetts (MA) is high relative to the national average. While the Winter 2021–2022 wave resulted in few excess deaths in MA, there was a rise in hospitalizations [ 3 ]. Still, as of October 2022, there were an appreciable number of eligible individuals who remained unvaccinated and a greater number who had not received boosters.…”

Section: Introductionmentioning

confidence: 99%

Inequities in COVID-19 vaccine and booster coverage across Massachusetts ZIP codes after the emergence of Omicron: A population-based cross-sectional study

et al. 2023

View full text Add to dashboard Cite

Background Inequities in Coronavirus Disease 2019 (COVID-19) vaccine and booster coverage may contribute to future disparities in morbidity and mortality within and between Massachusetts (MA) communities. Methods and findings We conducted a population-based cross-sectional study of primary series vaccination and booster coverage 18 months into the general population vaccine rollout. We obtained public-use data on residents vaccinated and boosted by ZIP code (and by age group: 5 to 19, 20 to 39, 40 to 64, 65+) from MA Department of Public Health, as of October 10, 2022. We constructed population denominators for postal ZIP codes by aggregating census tract population estimates from the 2015–2019 American Community Survey. We excluded nonresidential ZIP codes and the smallest ZIP codes containing 1% of the state’s population. We mapped variation in ZIP code-level primary series vaccine and booster coverage and used regression models to evaluate the association of these measures with ZIP code-level socioeconomic and demographic characteristics. Because age is strongly associated with COVID-19 severity and vaccine access/uptake, we assessed whether observed socioeconomic and racial/ethnic inequities persisted after adjusting for age composition and plotted age-specific vaccine and booster coverage by deciles of ZIP code characteristics. We analyzed data on 418 ZIP codes. We observed wide geographic variation in primary series vaccination and booster rates, with marked inequities by ZIP code-level education, median household income, essential worker share, and racial/ethnic composition. In age-stratified analyses, primary series vaccine coverage was very high among the elderly. However, we found large inequities in vaccination rates among younger adults and children, and very large inequities in booster rates for all age groups. In multivariable regression models, each 10 percentage point increase in “percent college educated” was associated with a 5.1 (95% confidence interval (CI) 3.9 to 6.3, p < 0.001) percentage point increase in primary series vaccine coverage and a 5.4 (95% CI 4.5 to 6.4, p < 0.001) percentage point increase in booster coverage. Although ZIP codes with higher “percent Black/Latino/Indigenous” and higher “percent essential workers” had lower vaccine coverage (−0.8, 95% CI −1.3 to −0.3, p < 0.01; −5.5, 95% CI −7.3 to −3.8, p < 0.001), these associations became strongly positive after adjusting for age and education (1.9, 95% CI 1.0 to 2.8, p < 0.001; 4.8, 95% CI 2.6 to 7.1, p < 0.001), consistent with high demand for vaccines among Black/Latino/Indigenous and essential worker populations within age and education groups. Strong positive associations between “median household income” and vaccination were attenuated after adjusting for age. Limitations of the study include imprecision of the estimated population denominators, lack of individual-level sociodemographic data, and potential for residential ZIP code misreporting in vaccination data. Conclusions Eighteen months into MA’s general population vaccine rollout, there remained large inequities in COVID-19 primary series vaccine and booster coverage across MA ZIP codes, particularly among younger age groups. Disparities in vaccination coverage by racial/ethnic composition were statistically explained by differences in age and education levels, which may mediate the effects of structural racism on vaccine uptake. Efforts to increase booster coverage are needed to limit future socioeconomic and racial/ethnic disparities in COVID-19 morbidity and mortality.

show abstract

“…Excess mortality is associated with the COVID-19 pandemic in causality, not in the magnitude of COVID-19 deaths. The two measures are not necessarily coupled, 2 and a strong evidence base exists to suggest that excess mortality is considerably driven by deaths other than COVID-19. 3 In many instances, deaths not related to COVID-19 have been shown to account for more than half of excess mortality.…”

mentioning

confidence: 99%

Underestimated COVID-19 mortality in WHO African region – Authors' reply

Cabore

Karamagi²,

Kipruto³

et al. 2022

The Lancet Global Health

View full text Add to dashboard Cite

Uncoupling of all-cause excess mortality from COVID-19 cases in a highly vaccinated state

Cited by 18 publications

References 5 publications

Two years of COVID-19: Excess mortality by age, region, gender, and race/ethnicity in the United States during the COVID-19 pandemic, March 1, 2020, through February 28, 2022

Two years of COVID-19: Excess mortality by age, region, gender, and race/ethnicity in the United States during the COVID-19 pandemic, March 1, 2020, through February 28, 2022

Inequities in COVID-19 vaccine and booster coverage across Massachusetts ZIP codes after the emergence of Omicron: A population-based cross-sectional study

Underestimated COVID-19 mortality in WHO African region – Authors' reply

Contact Info

Product

Resources

About