As of June 1, 2022, cumulative COVID-19 deaths per 100,000 residents were higher in rural (390) versus urban (293) counties in the U.S. Yet, deaths attributed to COVID-19 may be an underestimate of the overall mortality burden caused by the pandemic. Excess deaths provides a more complete measure of the total mortality effect of the pandemic and include:

• Deaths attributed to COVID-19 (i.e., COVID is documented as the underlying cause of death)
• Deaths indirectly caused by the pandemic (e.g., COVID is not the underlying cause of death—but the death could have been due to healthcare service delivery disruptions, suicide, drug overdose caused by the pandemic), and
• Deaths incorrectly identified on the death certificate as non-COVID-19 deaths.

The CDC maintains a dashboard to track excess deaths by state, age, cause of death, and race/ethnicity, but not by rurality. Researchers quantified excess deaths during the COVID-19 pandemic in the U.S. by rurality of residence using the CDC method. Researchers further estimated excess deaths by race/ethnicity groups, region of the U.S., COVID-19 surge, and the proportion of excess deaths that were attributed to COVID-19 (i.e., COVID-19 was documented as the underlying cause of death). Quantifying excess deaths during the COVID-19 pandemic by rurality of residence can inform rural health policy at the national level by highlighting rurality of county as a consideration when planning responses to future pandemics (targeting resources and mandates) and at the state level by identifying types of counties that may be most in need of supportive services. Highlighting disparities in excess deaths associated with the COVID-19 pandemic, which had so far not been examined, could lead to greater resources being directed to rural communities.

Publications

• Excess Deaths Associated With COVID-19 by Rurality and Demographic Factors in the United States
  Journal Article
  Maine Rural Health Research Center
  Date: 12/2023
  Researchers analyzed U.S. mortality data to quantify excess deaths during the COVID-19 pandemic to describe rural-urban disparities by age, sex, and race/ethnicity. There were nearly 17% more deaths than expected between March 2020 and February 2023.