In 2021, excess deaths rose in rural America

Despite the presence of vaccines, excess deaths in year two of the COVID-19 pandemic actually increased in rural areas, according to a new study.

Presumably, vaccines created specifically to fight a new and deadly disease should have caused a dramatic reduction in deaths from that disease. And, according to the new research, they did—but only in large, metropolitan counties. In rural counties across the United States, vaccines were harder to obtain, vaccine skepticism remained higher, and access to good health care is often more challenging.

The study provides the first look at monthly estimates of what the researchers call “excess deaths” for every US county in the pandemic’s first two years. It says an estimated 1,179,024 excess deaths occurred during those first two years (first: 634,830; second: 544,194), a figure found by comparing mortality rates across all US counties for those years versus the years 2015–2019.

“We define excess mortality as the difference between what was observed versus what we would have expected,” says Andrew Stokes, an assistant professor of global health at Boston University School of Public Health and corresponding author of the study.

Below, Stokes talks about the new study, which appears in the journal Science Advances. Among his other studies into COVID was one looking at “hidden deaths” from the disease—where he found the actual pandemic death toll could be 20% higher than the formal count.

This research had support from the Robert Wood Johnson Foundation, the National Institute on Aging, the W. K. Kellogg Foundation, the Boston University Center for Emerging Infectious Diseases Policy & Research, and the National Science Foundation.

(This interview has been edited for clarity; additional detail was also added after initial publication on The Brink.)

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