![]() ![]() ![]() First, some direct deaths attributable to Covid-19 may be assigned to other causes of death due to an absence of widespread testing and low rates of diagnoses at the time of death. Vital registration data sourced from death certificates on cause of death are likely to underestimate the mortality burden associated with the Covid-19 pandemic for several reasons. The United States has emerged as an epicenter of the Covid-19 pandemic, with over 18.2 million confirmed cases and 322,218 deaths as of Decem. SARS CoV-2 infects humans through the lung epithelium and is associated with a high incidence of acute respiratory distress syndrome, vascular injury, and death. The novel coronavirus disease 2019 (Covid-19) is an international public health emergency caused by the respiratory droplet transmission of the coronavirus-2 (SARS CoV-2) virus. 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. 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. 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. 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. 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. 15.9% of the population was older than 65 years. ![]() On average, the counties were 18.7% Hispanic, 12.7% non-Hispanic Black and 59.6% non-Hispanic White. The total number of residents living in these counties was 319.1 million. Our sample included 2,096 counties with 20 or more Covid-19 deaths. We used data with a ten 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. counties from January 1 to Decemand reported before March 12, 2021. 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 U.S. ![]()
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