ETSU Public Health researchers identified 322 excess deaths in Washington County,
Tenn.,
in 2020, of which just over half were specifically attributed to COVID-19.
Using publicly available funeral and obituary data, researchers from East Tennessee State University identified more than 300 excess deaths in Washington County alone in 2020 – of which just over half were specifically identified as being related to COVID-19 – in an article recently published in the Journal of Appalachian Health.
The study, “Using Public Funeral and Obituary Listings to Identify Spikes in Excess Mortality in One Appalachian County,” underscores the value in public health officials using such data to quickly and accurately identify “real-time” indications of excess mortality, such as in the aftermath of a natural disaster or during a pandemic.
Official death tolls can paint a limited picture of the true impact a pandemic or other disaster has on mortality rates. This study highlights the value of using more non-traditional data sources to quickly identify emerging trends.
“Having a variety of data sources and ways to understand data to determine if something might be different is valuable to epidemiology and public health as it can alert us to something earlier than usual,” said Dr. Megan Quinn, a professor in ETSU College of Public Health’s Department of Biostatistics and Epidemiology and one of the study’s co-authors.
Allen Archer, a medical student in ETSU’s Quillen College of Medicine, served as the study’s lead author. Archer was an undergraduate in the College of Public Health at the time the study was conducted. Dr. Melissa White-Archer, a research associate in the College of Public Health’s Department of Health Services Management and Policy, and Dr. Randy Wykoff, dean of the ETSU College of Public Health, also contributed to the study.
“While the world was attempting to understand the impact of the COVID-19 pandemic on a macro level, we focused our approach on utilizing readily available public data within the community to identify trends,” said Archer. “In doing so, we were able to identify spikes in mortality much faster than waiting for formal state-level death data. We believe that these methods could open the door for earlier identification and intervention at the local level in future disasters.
“I also believe this study highlights the importance of understanding epidemiology and public health in the context of community,” Archer continued. “Our community was able to tell us, through newspaper obituaries and local funeral home listings, what was going on in real time.”
By using official death reports, obituaries and funeral home data from 2017-19, researchers were able to set a baseline for expected deaths for 2020.
According to Wykoff, “following the number of obituaries in the newspapers, and funerals conducted by local funeral homes, can provide local health officials real-time information about changes in deaths in the community — months before official death reports become available.”
In 2020, the first year COVID-19 cases were documented in Washington County, Tennessee, the total number of deaths exceeded that baseline by 322, of which 165 were official, state-reported deaths from COVID-19.
In fact, prior to the first official COVID-related fatality in the county, researchers identified 96 excess deaths.
Quinn explained this could be due to several factors, such as limited testing early in the pandemic and people delaying needed medical care.
“Early in the COVID-19 pandemic, the case definition for a case of COVID-19 was fairly narrow and was then expanded as we learned more about the virus,” said Quinn. “Only people who met the case definition were tested for COVID due to limited resources. Additionally, things were uncertain and unknown about the virus, and people may have delayed care due to concerns about contracting the virus in a health care space.
“All of that may have increased deaths prior to the first official COVID-19 fatality,” Quinn continued.
Though COVID-19 does not dominate headlines the way it did just a few years ago, this research is part of ETSU’s commitment to more fully understanding the issues that impact Appalachia – whether that’s the pandemic, the opioid crisis or the devastation caused by Hurricane Helene in September.
“The dean and other faculty elevated and supported an undergraduate student to lead this project focused on regional public health,” said Archer. “These actions and their ongoing efforts to elevate students to lead similar regionally focused projects highlights the College of Public Health’s commitment to ETSU’s mission of enhancing student success and improving the quality of life in the region.”
To learn more about the ETSU College of Public Health, visit etsu.edu/cph/.
East Tennessee State University was founded in 1911 with a singular mission: to improve the quality of life for people in the region and beyond. Through its world-class health sciences programs and interprofessional approach to health care education, ETSU is a highly respected leader in rural health research and practices. The university also boasts nationally ranked programs in the arts, technology, computing, and media studies. ETSU serves approximately 14,000 students each year and is ranked among the top 10 percent of colleges in the nation for students graduating with the least amount of debt.
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