News Release

“Excess Mortality” During the Covid-19 Pandemic


A new study examines monthly excess deaths across counties in the U.S. from March 2020 to February 2022. “Excess mortality” is defined as the difference between expected and observed mortality. This is the first study to delve beyond federal- and state-level statistics to look into county-level deaths in more granularity. The authors found that excess mortality was concentrated in nonmetropolitan areas, “highlight[ing] the need for investments in rural health as the pandemic’s rural impact grows.”

    Stokes is a demographer and sociologist with expertise in population health and aging. 

Stokes, who co-authored the study, told the Institute for Public Accuracy that the rationale for it grew out of the lack of estimates for the “total effect of the pandemic on mortality at the community level.” Stokes said: “It’s essential to tell the stories of communities who [have been] disproportionately affected––including Black communities in the South, communities of agricultural workers in California, and communities in northern Arizona on reservation land.”

One of the most alarming findings from the data was the “tragic toll of the Delta wave on mortality in the rural South,” Stokes said. “Rural Southern communities, including Black communities, were heavily affected due to failures in state policies and a failure to support rural health infrastructure––especially the failure to get ‘shots in arms’ in these areas. It is unfortunately also the story of the toxic mix of partisanship and misinformation that led to lack of [vaccine] uptake, and high excess mortality, in white communities in the South. We saw this in the data from rural Florida to Mississippi to Alabama. In the second year of the pandemic, there was this tragic [excess death] toll, which was largely preventable due to the availability of vaccines. But the root causes differed across communities and counties.” In some counties, the death toll can be accounted for by the failure to enact state policies.

“Governor Ron DeSantis has touted Florida’s low mortality rate. On a state level, Florida performs equally relative to other states. But look at Central and Panhandle counties: on the county level, those counties had exceptionally high Covid excess mortality in the second year of the pandemic. In the end, Florida’s response was not as effective as they may advertise. Florida’s big population centers did fairly well, but that was counterbalanced by poor performance in rural areas. The same [was true in] Pennsylvania. State-level analysis loses some of the nuance of the increasing rural/urban divide.” 

Stokes added: “Some counties, like Navajo County in Arizona, are disproportionately reservation and Native American populations. We unfortunately see remarkably high excess mortality there even after a period of widespread vaccination, due to a combination of social and structural factors.” Those communities thus sustained high mortality “despite strong takeup of vaccines… You wouldn’t see that effect in Navajo County if you just look at Arizona.”

“There also is a misconception,” Stokes added, “that rural America [equals] white people. Black communities sustained excess Covid mortality in later stages of the pandemic, and that reflects lack of access.”

Accurate reporting of excess mortality is important given that community-level programs, such as the funeral assistance program run by FEMA, are sometimes distributed based on what ends up on a person’s death certificate. Stokes said: “Excess mortality statistics show the true pandemic toll, correcting for potential underreporting that’s happened across the country. In places like rural Oregon, Washington, or the South, a large proportion of deaths are occurring outside hospital settings. There, deaths might be getting assigned to Alzheimer’s or diabetes or heart disease.”