Evaluation of County-Level Heterogeneity in Excess Mortality in Colorado from March to September 2020

42 Pages Posted: 21 Apr 2021

See all articles by Jay Chandra

Jay Chandra

Harvard College

Marie Charpignon

Massachusetts Institute of Technology (MIT)

Mathew Samuel

Massachusetts Institute of Technology (MIT) - MIT Critical Data

Anushka Bhaskar

Harvard College

Saketh Sundar

Massachusetts Institute of Technology (MIT) - MIT Critical Data

Kirk Bol

Colorado Department of Public Health and Environment

Yuan Lai

Massachusetts Institute of Technology (MIT)

Leo Anthony Celi

Massachusetts Institute of Technology (MIT) - Laboratory for Computational Physiology

Sema Sgaier

Surgo Ventures

Grace Charles

Surgo Ventures

Maimuna S. Majumder

Boston Children's Hospital - Computational Health Informatics Program; Harvard University - Harvard Medical School

Date Written: April 9, 2021

Abstract

Importance: Tracking the direct and indirect impact of the coronavirus disease 2019 (COVID-19) pandemic on all-cause mortality in the United States has been hindered by the lack of testing and by reporting delays. Evaluating excess mortality, or the number of deaths above what is expected in a given time period, provides critical insights into the true burden of the COVID-19 pandemic caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Stratifying mortality data by demographics such as age, sex, race, ethnicity, and geography helps quantify how subgroups of the population have been differentially affected. Similarly, stratifying mortality data by cause of death reveals the public health effects of the pandemic in terms of other acute and chronic diseases.

Objective: To provide stratified estimates of excess mortality in Colorado from March to September 2020.

Design, Setting, and Population: This study evaluated the number of excess deaths both directly due to SARS-CoV-2 infection and from all other causes between March and September 2020 at the county level in Colorado. Data were obtained from the Vital Statistics Program at the Colorado Department of Public Health and Environment. These estimates of excess mortality were derived by comparing population- adjusted mortality rates in 2020 with rates in the same months from 2015 to 2019.

Results: We found evidence of excess mortality in Colorado between March and September 2020. Two peaks in excess deaths from all causes were recorded in the state, one mid-April and the other at the end of June. Since the first documented SARS-CoV-2 infection on March 5th, we estimated that the excess mortality rate in Colorado was two times higher than the officially reported COVID-19 mortality rate. State-level cumulative excess mortality from all causes reached 71 excess deaths per 100k residents (~4000 excess deaths in the state); in contrast, 35 deaths per 100k directly due to SARS-CoV-2 were recorded in the same period (~1980 deaths. Excess mortality occurred in 52 of 64 counties, accounting for 99% of the state’s population. Most excess deaths recorded from March to September 2020 were associated with acute events (estimated at 44 excess deaths per 100k residents and at 9 after excluding deaths directly due to SARS-CoV-2) rather than with chronic conditions (~21 excess deaths per 100k). Among Coloradans aged 14-44, 1.4 times more deaths occurred in those months than during the same period in the five previous years. Hispanic White males died of COVID-19 at the highest rate during this time (~90 deaths from COVID-19 per 100k residents); however, Non-Hispanic Black/African American males were the most affected in terms of overall excess mortality (~204 excess deaths per 100k). Beyond inequalities in COVID-19 mortality per se, these findings signal considerable regional and racial-ethnic disparities in excess all-cause mortality that need to be addressed for a just recovery and in future public health crises.

Note: Funding Statement: Dr. Leo A. Celi was funded by the NIH through NIBIB grant R01 EB017205. Dr. Maimuna S. Majumder was supported in part by grant T32HD040128 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NIH).

Declaration of Interests: The authors have no competing interest to declare.

Ethics Approval Statement: We received approval from MIT COUHES to conduct this research. We are also bounded by our Data Use Agreement with the Vital Statistics Program led by Kirk Bol at the Colorado Department of Public Health and Environment.

Keywords: Excess Mortality, COVID-19, SARS-CoV-2, Colorado, Health Policy, Health Equity

Suggested Citation

Chandra, Jay and Charpignon, Marie and Samuel, Mathew and Bhaskar, Anushka and Sundar, Saketh and Bol, Kirk and Lai, Yuan and Celi, Leo Anthony and Sgaier, Sema and Charles, Grace and Majumder, Maimuna, Evaluation of County-Level Heterogeneity in Excess Mortality in Colorado from March to September 2020 (April 9, 2021). Available at SSRN: https://ssrn.com/abstract=3823583 or http://dx.doi.org/10.2139/ssrn.3823583

Jay Chandra (Contact Author)

Harvard College ( email )

Cambridge, MA 02138
United States

Marie Charpignon

Massachusetts Institute of Technology (MIT) ( email )

77 Massachusetts Avenue
50 Memorial Drive
Cambridge, MA 02139-4307
United States

Mathew Samuel

Massachusetts Institute of Technology (MIT) - MIT Critical Data ( email )

Cambridge, MA 20139
United States

Anushka Bhaskar

Harvard College ( email )

Cambridge, MA 02138
United States

Saketh Sundar

Massachusetts Institute of Technology (MIT) - MIT Critical Data ( email )

Cambridge, MA 20139
United States

Kirk Bol

Colorado Department of Public Health and Environment ( email )

4300 Cherry Creek S Dr
Denver, CO 80246
United States

Yuan Lai

Massachusetts Institute of Technology (MIT) ( email )

77 Massachusetts Avenue
50 Memorial Drive
Cambridge, MA 02139-4307
United States

Leo Anthony Celi

Massachusetts Institute of Technology (MIT) - Laboratory for Computational Physiology ( email )

Cambridge, MA 20139
United States

Sema Sgaier

Surgo Ventures ( email )

Washington, DC 20001
United States

Grace Charles

Surgo Ventures ( email )

Washington, DC 20001
United States

Maimuna Majumder

Boston Children's Hospital - Computational Health Informatics Program ( email )

United States

Harvard University - Harvard Medical School ( email )

25 Shattuck St
Boston, MA 02115
United States

Do you have a job opening that you would like to promote on SSRN?

Paper statistics

Downloads
36
Abstract Views
249
PlumX Metrics