Analysis shows that the death toll from a true pandemic in the United States is well above 200,000.

The Centers for Disease Control and Prevention (CDC) announced last week that the United States has passed a tough milestone. Currently, more than 200,000 Americans have died of COVID-19. However, according to a study by the Boston University School of Public Health, the actual number of losses can be much higher.

That analysis, Available in medRxiv Prior to the peer-reviewed publication, we examined the number of deaths in the United States from February to September 2020. These deaths are characterized as exceeding the expected number of deaths in a normal year. Researchers found that for every 100 over-deaths directly due to COVID-19, there were an additional 36 over-deaths. This may also be due to COVID-19, but it’s not very obvious.

BU researchers working with collaborators from the University of Pennsylvania and the Robert Wood Johnson Foundation found these additional deaths in US counties with wide income inequality, a high proportion of non-Hispanic black residents, and low home ownership. I found that there are many people. The population density is high. The data suggest that higher mortality rates are closely associated with socio-economic disadvantages and structural racism.

According to the lead author of the study, finding out where the most excessive deaths occurred is a better measure of the disproportionate impact of a pandemic on the community than simply counting the total number of COVID-19-related deaths. Andrew Stokes, Associate Professor of Global Health, BU School of Public Health. “Excessive deaths include COVID deaths from other causes and the indirect consequences of a pandemic on society,” he says.

Indirect consequences include those who are afraid to go to the hospital for another condition for fear of catching the coronavirus, or the loss of health insurance after the layoff, the financial and mental aspects of COVID-19. It can include many other problems caused or exacerbated by health effects. A condition in which you cannot afford to buy reduced medication, or the rate of depression in adults in the United States, which adversely affects many aspects of health.

For their analysis, Stokes and his collaborators from the National Center for Health Statistics (NCHS) in 1,021 counties with more than 10 COVID-19 deaths between February 1st and September 23rd. We examined county-level mortality data in the country. At the national and state levels, this is the first study to investigate the problem at the county level, and researchers will better investigate how patterns of excess mortality change due to demographic and social structural factors. I can.

“Our results draw significant attention to the different impacts of the COVID-19 pandemic on low-income and minority communities that have experienced historically high mortality,” said the study’s co-author, Professor UPenn. Irma T. Elo, the chair of the university, said. These disproportionate mortality rates are “further exacerbated by the current pandemic.”

As a baseline for comparison, researchers edited CDC data from 2013 to 2018 to estimate the expected number of deaths in each county during this period without the COVID-19 pandemic.

They found that for a total of 249,167 excess deaths in these 1,021 counties, there were 183,686 deaths assigned directly to COVID-19 on the death certificate and 65,481 excess deaths not officially assigned to COVID-19. I found that it was. This means that 26% of all excess mortality was not directly due to COVID-19. This means that the actual mortality was 36% higher than the officially due to COVID-19.

“Even in counties with high COVID-19 mortality, there were very high mortality rates from other causes of death in 2020,” said Samuel H. Preston, a senior author of the study, a professor of sociology at the University of Pennsylvania. I am. “This result suggests that the epidemic is the cause of far more deaths than COVID-19 alone.”

Most counties suffered more deaths than expected in normal years, while some counties experienced less than normal deaths. Combining it with demographic and structural factors collected by US census data, researchers found that the communities identified as the most hit by the COVID-19 pandemic were more than official figures indicate. It suggests that more lives may have been lost.

“As a result of the COVID pandemic, racial and socio-economic inequality in US mortality has increased significantly,” said research co-author and BU researcher. Diel Landberg (SPH’19). “To protect public health, policy makers must act decisively to address structural racism and reduce income inequality.”

This study was also co-authored by Catherine Hempstead of the Robert Wood Johnson Foundation and funded by the Robert Wood Johnson Foundation.