U.S. deaths normally change less than 2% each year Black Americans experienced highest per capita excess death rates, while regional surges contributed to higher excess death rates from COVID-19 and other causes, a VCU-led JAMA study finds.
ByMary Kate Brogan, Virginia
Commonwealth University
April 2, 2021 -- Extended surges
in the South and West in the summer and early winter of 2020 resulted in
regional increases in excess death rates, both from COVID-19 and from other
causes, a 50-state analysis of excess death trends has found. Virginia
Commonwealth University researchers’ latest study notes that Black Americans
had the highest excess death rates per capita of any racial or ethnic group in
2020.
The research, published
Friday in the Journal of the American Medical Association, offers new
data from the last 10 months of 2020 on how many Americans died during 2020 as
a result of the effects of the pandemic — beyond the number of COVID-19 deaths
alone — and which states and racial groups were hit hardest.
The rate of excess deaths — or
deaths above the number that would be expected based on averages from the
previous five years — is usually consistent, fluctuating 1% to 2% from year to
year, said Steven
Woolf, M.D., the study’s lead author and director emeritus of
VCU’s Center on Society and
Health. From March 1, 2020, to Jan. 2, 2021, excess deaths rose a
staggering 22.9% nationally, fueled by COVID-19 and deaths from other causes,
with regions experiencing surges at different times.
“COVID-19 accounted for roughly 72% of
the excess deaths we’re calculating, and that’s similar to what
our earlier studies showed. There is a sizable gap between the
number of publicly reported COVID-19 deaths and the sum total of excess deaths
the country has actually experienced,” Woolf said.
For the other 28% of the nation’s
522,368 excess deaths during that period, some may actually have been from
COVID-19, even if the virus was not listed on the death certificates due to
reporting issues.
But Woolf said disruptions caused by the
pandemic were another cause of the 28% of excess deaths not attributed to
COVID-19. Examples might include deaths resulting from not seeking or finding
adequate care in an emergency such as a heart attack, experiencing fatal
complications from a chronic disease such as diabetes, or facing a behavioral
health crisis that led to suicide or drug overdose.
“All three of those categories could
have contributed to an increase in deaths among people who did not have
COVID-19 but whose lives were essentially taken by the pandemic,” said Woolf, a
professor in the Department
of Family Medicine and Population Health at the VCU School of Medicine.
The percentage of excess deaths among
non-Hispanic Black individuals (16.9%) exceeded their share of the U.S.
population (12.5%), reflecting racial disparities in mortality due to COVID-19
and other causes of death in the pandemic, Woolf and his co-authors write in
the paper. The excess death rate among Black Americans was higher than rates of
excess deaths among non-Hispanic white or Hispanic populations.
Woolf said his team was motivated to
break down this information by race and ethnicity due to mounting evidence that
people of color have experienced an increased risk of death from COVID-19.
“We found a disproportionate number of
excess deaths among the Black population in the United States,” said Woolf, VCU’s
C. Kenneth and Dianne Wright Distinguished Chair in Population Health and
Health Equity. “This, of course, is consistent with the evidence about COVID-19
but also indicates that excess deaths from some conditions other than COVID-19
are also occurring at higher rates in the African American population.”
Surges in excess deaths varied across
regions of the United States. Northeastern states, such as New York and New
Jersey, were among the first hit by the pandemic. Their pandemic curves looked
like a capital “A,” Woolf said, peaking in April and returning rapidly to
baseline within eight weeks because strict restrictions were put in place. But
the increase in excess deaths lasted much longer in other states that lifted
restrictions early and were hit hard later in the year. Woolf cited economic or
political reasons for decisions by some governors to weakly embrace, or
discourage, pandemic control measures such as wearing masks.
“They said they were opening early to
rescue the economy. The tragedy is that policy not only cost more lives, but
actually hurt their economy by extending the length of the pandemic,” Woolf
said. “One of the big lessons our nation must learn from COVID-19 is that our
health and our economy are tied together. You can’t really rescue one without
the other.”
According to the study’s data, the 10
states with the highest per capita rate of excess deaths were Mississippi, New
Jersey, New York, Arizona, Alabama, Louisiana, South Dakota, New Mexico, North
Dakota and Ohio.
Nationally, Woolf expects the U.S. will
see consequences of the pandemic long after this year. For example, cancer
mortality rates may increase in the coming years if the pandemic forced people
to delay screening or chemotherapy.
Woolf said future illness and deaths
from the downstream consequences of the devastated economy could be addressed
now by “bringing help to families, expanding access to health care, improving
behavioral health services and trying to bring economic stability to a large
part of the population that was already living on the edge before the
pandemic.” Among other research, his team’s 2019
JAMA study of working-age mortality underscores the importance of
prioritizing public health measures like these, he said.
“American workers are sicker and dying
earlier than workers in businesses in other countries that are competing
against America,” Woolf said. “So investments to help with health are important
for the U.S. economy in that context just as they are with COVID-19.”
Derek Chapman, Ph.D., Roy Sabo, Ph.D.,
and Emily Zimmerman, Ph.D., of VCU’s Center on Society and Health and the
School of Medicine joined Woolf as co-authors on the paper published
Friday, “Excess Deaths From COVID-19 and Other Causes in the United States,
March 1, 2020, to January 2, 2021.”
Their study also confirms a trend
Woolf’s team noted in an
earlier 2020 study: Death rates from several non-COVID-19 conditions,
such as heart disease, Alzheimer’s disease and diabetes, increased during
surges.
“This country has experienced profound
loss of life due to the pandemic and its consequences, especially in
communities of color,” said Peter Buckley, M.D., dean of the VCU School of
Medicine. “While we must remain vigilant with social distancing and
mask-wearing behaviors for the duration of this pandemic, we must also make
efforts to ensure the equitable distribution of care if we are to reduce the likelihood
of further loss of life.”
Based on current trends, Woolf said the
surges the U.S. has seen might not be over, even with vaccinations underway.
“We’re not out of the woods yet because
we’re in a race with the COVID-19 variants. If we let up too soon
and don’t maintain public health restrictions, the vaccine may not win out over
the variants,” Woolf said. “Unfortunately, what we’re seeing is that many
states have not learned the lesson of 2020. Once again, they are lifting restrictions,
opening businesses back up, and now seeing the COVID-19 variants spread through
their population.
“To prevent more excess deaths, we need
to hold our horses and maintain the public health restrictions that we have in
place so the vaccine can do its work and get the case numbers under control.”
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