Excess deaths associated with COVID-19 by rurality and demographic factors in the United States

Details

• Alternative Title:
  J Rural Health
• Personal Author:
  Ahrens, Katherine A. ; Rossen, Lauren M. ; Milkowski, Carly ; Gelsinger, Catherine ; Ziller, Erika
• Description:
  Purpose:
  
  To estimate percent excess deaths during the COVID-19 pandemic by rural-urban residence in the United States and to describe rural-urban disparities by age, sex, and race/ethnicity.
  
  Methods:
  
  Using US mortality data, we used overdispersed Poisson regression models to estimate monthly expected death counts by rurality of residence, age group, sex, and race/ethnicity, and compared expected death counts with observed deaths. We then summarized excess deaths over 6 6-month time periods.
  
  Findings:
  
  There were 16.9% (95% confidence interval [CI]: 16.8, 17.0) more deaths than expected between March 2020 and February 2023. The percent excess varied by rurality (large central metro: 18.2% [18.1, 18.4], large fringe metro: 15.6% [15.5, 15.8], medium metro: 18.1% [18.0, 18.3], small metro: 15.5% [15.3, 15.7], micropolitan rural: 16.3% [16.1, 16.5], and noncore rural: 15.8% [15.6, 16.1]). The percent excess deaths were 20.2% (20.1, 20.3) for males and 13.6% (13.5, 13.7) for females, and highest for Hispanic persons (49% [49.0, 49.6]), followed by non-Hispanic Black persons (28% [27.5, 27.9]) and non-Hispanic White persons (12% [11.6, 11.8]). The 6-month time periods with the highest percent excess deaths for large central metro areas were March 2020-August 2020 and September 2020-February 2021; for all other areas, these time periods were September 2020-February 2021 and September 2021-February 2022.
  
  Conclusion:
  
  Percent excess deaths varied by rurality, age group, sex, race/ethnicity, and time period. Monitoring excess deaths by rurality may be useful in assessing the impact of the pandemic over time, as rural-urban patterns appear to differ.
  
  
• Subjects:
  Adolescent Adult Aged Aged, 80 And Over Child Child, Preschool COVID-19 Demography Ethnicity Female Humans Infant Infant, Newborn Male Middle Aged Mortality Pandemics Rural Population SARS-CoV-2 United States Urban Population Young Adult

  More +
• Keywords:
  Demography Epidemiology Social Determinants Of Health
• Source:
  J Rural Health. 40(3):491-499
• Pubmed ID:
  38082546
• Pubmed Central ID:
  PMC11164822
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  40
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:1cfef32f14f2a07409c0fa5b20e2044e479414fbb2fadcd36434be469ed18300
• Download URL:
  https://stacks.cdc.gov/view/cdc/157945/cdc_157945_DS1.pdf
• File Type:
  [PDF - 366.56 KB ]