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Association of Health Care Factors With Excess Deaths Not Assigned to COVID-19 in the US

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Approximately 20% of excess deaths in the US in 2020 were not reflected in COVID-19 death counts.13 These excess deaths included deaths caused by COVID-19 but not assigned to it as well as indirect deaths from other causes associated with delays in health care and the social and economic consequences of the pandemic. Prior research has documented differences in the percentage of excess deaths not assigned to COVID-19 at the state and county levels.1,3,4 In this study, we examined health care factors associated with excess deaths not assigned to COVID-19 at the county level.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: July 12, 2021.

Published: September 13, 2021. doi:10.1001/jamanetworkopen.2021.25287

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Stokes AC et al. JAMA Network Open.

Corresponding Author: Andrew C. Stokes, PhD, Boston University School of Public Health, 801 Massachusetts Ave, 3rd Flr, Ste 362, Boston, MA 02118 (acstokes@bu.edu).

Author Contributions: Dr Stokes and Ms Lundberg had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Stokes, Lundberg, Elo, Hempstead, Preston.

Acquisition, analysis, or interpretation of data: Stokes, Lundberg, Bor, Hempstead.

Drafting of the manuscript: Stokes, Lundberg.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Stokes, Lundberg, Bor, Preston.

Obtained funding: Stokes, Elo.

Administrative, technical, or material support: Bor, Elo.

Supervision: Stokes.

Conflict of Interest Disclosures: Dr Stokes reported receiving grants from Ethicon Inc and Swiss Re outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by grant 77521 from the Robert Wood Johnson Foundation (Dr Stokes) and grant R01 AG060115 from the National Institute on Aging, National Institutes of Health (Dr Elo).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The interpretations, conclusions, and recommendations in this work are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation.

Additional Contributions: Charlie B. Fischer, BS (Department of Global Health, Boston University School of Public Health, Boston, Massachusetts), contributed to data collection and received compensation for the work.

References
1.
Woolf  SH , Chapman  DA , Sabo  RT , Weinberger  DM , Hill  L , Taylor  DDH .  Excess deaths From COVID-19 and other causes, March-July 2020.   JAMA. 2020;324(15):1562-1564. doi:10.1001/jama.2020.19545 PubMedGoogle ScholarCrossref
2.
Weinberger  DM , Chen  J , Cohen  T ,  et al.  Estimation of excess deaths associated with the COVID-19 pandemic in the United States, March to May 2020.   JAMA Intern Med. 2020;180(10):1336-1344. doi:10.1001/jamainternmed.2020.3391 PubMedGoogle ScholarCrossref
3.
Stokes  AC , Lundberg  DJ , Elo  IT , Hempstead  K , Bor  J , Preston  SH . COVID-19 and excess mortality in the United States: a county-level analysis.  PLOS Medicine. 2021;18:e1003571. doi:10.1371/journal.pmed.1003571
4.
Chen  Y-H , Glymour  MM , Catalano  R ,  et al.  Excess mortality in California during the coronavirus disease 2019 pandemic, March to August 2020.   JAMA Internal Medicine. 2020. doi:10.1001/jamainternmed.2020.7578PubMedGoogle Scholar
5.
Yang  M , McNabney  MK .  Physicians’ responsibilities for deaths occurring at home.   J Am Geriatr Soc. 2017;65(3):648-652. doi:10.1111/jgs.14709 PubMedGoogle ScholarCrossref
6.
Institute of Medicine.  Medicolegal Death Investigation System: Workshop Summary. The National Academies Press; 2003. doi:10.17226/10792
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