State-Level Excess Mortality in US Adults During the Delta and Omicron Waves of COVID-19

Introduction The US has continued to see excess mortality through the Delta and Omicron periods. We sought to quantify excess mortality on a state level and calculate potential deaths averted if all states matched the excess mortality rates of those with the 10 lowest excess mortality rates. Methods Observational cohort, US and state-level data. Expected monthly deaths were modeled using pre-pandemic US and state-level data (2015-2020). Mortality data was accessed from CDC public reporting. Results We find that during the Delta and Omicron waves, the US recorded over 596,000 excess deaths. 60% of the nation’s total excess mortality during these periods could have been averted if all states had excess mortality rates equal to those with the 10 lowest excess mortality rates. Conclusion With large differences in excess mortality across US states in this 15-month study period, we note that a significant portion of deaths could have been averted with higher vaccination rates, improved mitigation policies, and adherence to other behaviors. ### Competing Interest Statement Dr. Krumholz reported receiving consulting fees from UnitedHealth, Element Science, Aetna, Reality Labs, F-Prime, and Tesseract/4Catalyst; serving as an expert witness for Martin/Baughman law firm, Arnold and Porter law firm, and Siegfried and Jensen law firm; being a cofounder of Hugo Health, a personal health information platform; being a cofounder of Refactor Health, an enterprise health care, artificial intelligence-augmented data management company; receiving contracts from the Centers for Medicare & Medicaid Services through Yale New Haven Hospital to develop and maintain performance measures that are publicly reported; and receiving grants from Johnson & Johnson outside the submitted work. No other disclosures were reported. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors