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Excess Death Rates by State During the COVID-19 Pandemic: United States, 2020‒2023.

Steven H Woolf1, Jong Hyung Lee1, Derek A Chapman1

  • 1Steven H. Woolf and Jong Hyung Lee are with the Department of Family Medicine, Virginia Commonwealth University (VCU) School of Medicine, Richmond. Derek A. Chapman and Emily Zimmerman are with the Department of Epidemiology, VCU School of Population Health, Richmond. Roy T. Sabo is with the Department of Biostatistics, VCU School of Population Health.

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Excess death rates varied by US state and region during the COVID-19 pandemic. Higher rates were observed in states with Republican leadership, particularly after vaccines became available.

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Area of Science:

  • Public Health
  • Epidemiology
  • Political Science

Background:

  • The COVID-19 pandemic caused significant mortality in the United States.
  • Understanding geographic and political variations in excess death rates is crucial for public health policy.

Purpose of the Study:

  • To estimate state-level excess death rates from March 2020 to July 2023.
  • To analyze regional differences and associations with partisan orientation in excess mortality.

Main Methods:

  • Utilized Centers for Disease Control and Prevention (CDC) death and population data.
  • Modeled excess death rates across the US, census divisions, and states.
  • Compared rates based on state governor's party and legislative representation.

Main Results:

  • Over 1.27 million excess deaths occurred in the US between March 2020 and July 2023.
  • Nearly 90% of excess deaths were COVID-19 related; over half occurred post-vaccine availability.
  • Excess death rates shifted geographically and were higher in Republican-led states before March 2022.

Conclusions:

  • Significant variation in excess death rates existed across US states during the pandemic.
  • Partisan representation in state government was associated with excess death rates, though confounding factors may exist.