A sick nursing home resident lies in bed
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Excess mortality in the United States reached nearly 1.2 million during the first 2 years of the pandemic, according to new estimates published Saturday in the journal Science Advances. The findings may reveal geographic disparities and gaps in vaccine uptake that should be remedied, investigators say.

Excess mortality is the difference between expected and observed mortality. The new study is the first to examine county-level estimates of excess mortality by month, from March 2020 through February 2022, the researchers said. 

In the pandemic’s first year, 634,830 excess deaths occurred. Yet the numbers remained surprisingly high in year two, which saw 544,194 excess deaths. That’s noteworthy, as vaccinations were available for much of 2021 and 2022, Eugenio Paglino, of the University of Pennsylvania, Philadelphia, and colleagues said.

Gaps in vaccine uptake likely contributed to this continued excess mortality and “may persist into the future if these vaccination gaps are not closed,” the authors wrote. The finding may also reflect a failure of governments to invest in broad protective strategies that might have further mitigated COVID-19 spread, from vaccine and booster delivery programs to medical leave for essential workers to improved workplace ventilation, they added. 

The results also showed geographic trends in mortality that may highlight care inequities, the investigators reported. Excess deaths were at first concentrated in the large metropolitan counties of the Northeast. But by the end of February 2022, nonmetro areas in the South had the highest cumulative relative excess mortality, with the increases occurring mostly during the delta wave of the pandemic.

“These results highlight the need for investments in rural health as the pandemic’s rural impact grows,” the authors concluded.

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