Mortality rates return to pre-COVID-19 ‘normal’ for most groups in the US
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Key takeaways:
- Although mortality rates have largely returned to pre-pandemic levels, disparities among minority populations persist.
- Rural and nonmetropolitan areas also have higher levels of mortality than before the pandemic.
Mortality in the United States has returned to pre-COVID-19 pandemic levels for the most part, but several groups continue to experience disparities that existed before March 2020, according to a study.
Kaitlyn M. Berry, MPH, a doctoral candidate in epidemiology at the University of Minnesota School of Public Health, and colleagues wrote in JAMA Network Open that mortality in the U.S. has stabilized and returned to similar levels and patterns as before the emergence of SARS-CoV-2.
Returning to “normal,” however, means “stark mortality disparities” for some populations, including Black Americans and people who live in rural areas of the country, they said.
“There has been a public debate about whether the U.S. has ‘returned to normal’ after the pandemic,” Berry and colleagues wrote. “Our study suggests that this has largely been the case with respect to disparities by gender, race and ethnicity and region. Although mortality is largely proportional to 2018-2019 mortality with respect to major demographic comparisons.”
Berry and colleagues analyzed mortality data from the National Center for Health Statistics and data from the U.S. Census Bureau to calculate annualized age-standardized death rates from March 1, 2018, to May 31, 2023, by sex, race and ethnicity; metropolitan status; and region. They then estimated annual mortality rates over four time frames — before the pandemic from March 2018 to February 2020; March 2020 to February 2021, the first year of the pandemic before vaccines were available; March 2021 to February 2022, after vaccines became widely available; and a post-acute period from March 2022 to May 2023, after the first wave of SARS-CoV-2 omicron viruses.
Overall, mortality in the U.S. increased during the two acute pandemic phases and have returned to the near-pre-pandemic levels for most groups, according to the researchers.
Mortality increased more for men, all minority racial and ethnic groups, people in nonmetropolitan areas and in the South. The researchers noted that, specifically, American Indian or Alaska Native vs. white mortality increased the highest during the acute years of the pandemic, although they also have since returned to pre-pandemic levels.
The researchers also noted that mortality in the post-acute pandemic period was more heavily concentrated in nonmetropolitan areas than before the pandemic, potentially because of rural hospital closings and increased political polarization around vaccination and other preventive health care.
“This continuity suggests that these disparities are persistent — even a pandemic level mortality shock does not permanently alter them,” Berry and colleagues wrote. “This return to the high pre-pandemic level of mortality disparities reflects a failure to implement longer term policy changes — such as universal paid sick leave, greater workplace rights to clean air and stronger public health infrastructure — that might have further reduced these disparities once the acute pandemic ended.”
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