Excess mortality, COVID deaths, and spatial accessibility to health care services in the conterminous United States

Abstract

Since the onset of COVID 19, the pandemic has put extra burden on mortality in the United States. This study aims to investigate the regional variations of death rates and the associations between excess deaths and the underlying population characteristic and spatial access to medical services during the pandemic. To this end, this study estimated the excess deaths in 2020 and the travel times to the nearest healthcare facilities, PCP ratios, and medical facility to population ratios at the county level in the conterminous United States. Coupling the death data with population characteristics, socio-economic factors, health factors and access to healthcare facilities, this study employed spatial statistical methods, including global and local spatial autocorrelation analyses, bivariate spatial analysis and geographically weighted generalized linear regression to investigate their relationships. The results revealed that the impact of COVID varied across the country. The South, particularly the Deep South, was hit the hardest. Compared to the spatially varying relationship between COVID deaths, unemployment, minority, smoking rates and excess deaths, poverty was the primary factor linked to excess deaths nationally. While the access to healthcare services was not associated with excess deaths in general, it did vary significantly between counties with high/low death rates.