Excess natural-cause mortality in US counties and its association with reported COVID-19 deaths

The study titled “Excess Natural-Cause Mortality in US Counties and Its Association with Reported COVID-19 Deaths,” conducted by Paglino et al., 2024, offers a comprehensive analysis of the disparities between reported COVID-19 deaths and excess deaths due to natural causes in the United States during the first 30 months of the COVID-19 pandemic (March 2020 through August 2022). This detailed examination sheds light on the magnitude of the pandemic’s impact, highlighting significant underreporting of COVID-19 deaths and its implications.

Study Overview

Utilizing a Bayesian hierarchical model, the research team estimated monthly excess natural-cause mortality rates across all U.S. counties. The model aimed to identify the extent to which reported COVID-19 deaths reflected the actual number of deaths attributable to the pandemic, considering natural causes of death beyond direct COVID-19 fatalities.

Key Findings

  1. Excess Mortality Estimates: The study estimated a staggering 1,194,610 excess natural-cause deaths nationwide during the study period, with a significant portion, approximately 162,886 (13.6%), not reported as COVID-19 deaths. This discrepancy suggests a considerable underestimation of the pandemic’s true death toll.
  2. Geographic and Demographic Variations: Nonmetropolitan counties, as well as regions in the West and the South, experienced higher ratios of excess deaths to reported COVID-19 deaths. This geographic variation indicates that the impact of the pandemic, and potentially the underreporting of COVID-19 deaths, varied significantly across different parts of the country and among various population densities.
  3. Temporal Correlations: The analysis revealed a strong temporal correlation between reported COVID-19 deaths and excess deaths due to natural causes, suggesting that many excess deaths were likely unrecognized COVID-19 fatalities. This correlation was observed across nearly all Census divisions and metropolitan-nonmetropolitan categories, indicating a widespread pattern of excess mortality concurrent with reported COVID-19 deaths.
  4. Unrecognized COVID-19 Deaths: The study posits that a substantial number of excess deaths attributed to natural causes were, in fact, unrecognized COVID-19 deaths. This assertion is supported by the temporal alignment of excess death peaks with reported COVID-19 death peaks and the overall excess death toll exceeding COVID-19 reporting figures.
  5. Public Health Implications: The findings underscore the need for more accurate mortality data and reporting mechanisms. Improved surveillance and reporting could enhance public health responses and resource allocation, particularly in communities most affected by the pandemic.

Conclusions and Recommendations

Paglino et al.’s study highlights the significant underestimation of COVID-19’s mortality impact through official death counts. By revealing the discrepancies between reported COVID-19 deaths and excess natural-cause deaths, the research underscores the necessity for enhanced mortality surveillance and reporting systems. Addressing these gaps is crucial for better understanding the pandemic’s full impact, improving public health strategies, and preparing for future health emergencies. The study calls for targeted efforts to improve the accuracy and completeness of mortality data, which is essential for effective public health interventions and policies.

Read More: https://www.pnas.org/doi/10.1073/pnas.2313661121

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