A new study has identified healthcare factors associated with excess deaths that have not been assigned to COVID-19 at the county level across the US. The study found that a greater proportion of excess deaths not reflected in COVID-19 death counts occurred in counties with reduced access to health insurance and primary care services, as well as in counties with more deaths that occurred at home.

Now, a new study from Boston University School of Public Health (BUSPH) and the University of Pennsylvania (Penn) has identified healthcare factors associated with excess deaths that have not been assigned to COVID-19 at the county level across the US.

Published in the journal JAMA Network Open, the study found that a greater proportion of excess deaths not reflected in COVID-19 death counts occurred in counties with reduced access to health insurance and primary care services, as well as in counties with more deaths that occurred at home.

«Accurate and timely mortality surveillance is critical to a well-functioning and equitable public health system,» says Andrew Stokes, lead author and professor of global health at BUSPH. «In the context of COVID, inaccuracies in cause of death ascertainment have hidden the true scale of the pandemic and its vastly uneven impact across communities. In the present study, we find that discrepancies between official COVID death tallies and excess mortality estimates were especially severe in areas with poor health care access and more at-home deaths.

«These differences suggest an urgent need to increase funding and support for the U.S. medicolegal death investigation system, which is often involved in certifying home deaths,» Stokes says.

The study builds upon earlier findings by the researchers, who found that excess deaths not directly attributed to COVID-19 were higher in counties with lower socioeconomic status and less formal education, as well as in counties located in the South and West, and counties with more non-Hispanic Black residents. In the JAMA Network Open study, Stokes and colleagues used publicly available data from the National Center for Health Statistics, the Centers for Disease Control and Prevention, and the US Census Bureau to compare the percentage of excess deaths not attributed to COVID in 2,096 counties in 2020 with county-level information on residents’ access to healthcare and locations in which excess deaths occurred.

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Materials provided by Boston University School of Medicine. Original written by Jillian McKoy. Note: Content may be edited for style and length.