{"doi":"10.1093/pnasnexus/pgac079","title":"Excess natural-cause deaths in California by cause and setting: March 2020 through February 2021","abstract":"Excess mortality has exceeded reported deaths from Covid-19 during the pandemic. This gap may be attributable to deaths that occurred among individuals with undiagnosed Covid-19 infections or indirect consequences of the pandemic response such as interruptions in medical care; distinguishing these possibilities has implications for public health responses. In the present study, we examined patterns of excess mortality over time and by setting (in-hospital or out-of-hospital) and cause of death using death certificate data from California. The estimated number of excess natural-cause deaths from 2020 March 1 to 2021 February 28 (69,182) exceeded the number of Covid-19 diagnosed deaths (53,667) by 29%. Nearly half, 47.4% (32,775), of excess natural-cause deaths occurred out of the hospital, where only 28.6% (9,366) of excess mortality was attributed to Covid-19. Over time, increases or decreases in excess natural non-Covid-19 mortality closely mirrored increases or decreases in Covid-19 mortality. The time series were positively correlated in out-of-hospital settings, particularly at time lags when excess natural-cause deaths preceded reported Covid-19 deaths; for example, when comparing Covid-19 deaths to excess natural-cause deaths in the week prior, the correlation was 0.73. The strong temporal association of reported Covid-19 deaths with excess out-of-hospital deaths from other reported natural-cause causes suggests Covid-19 deaths were undercounted during the first year of the pandemic.","journal":"PNAS Nexus","year":2022,"id":251199,"datarank":0.4887144807032224,"base_score":3.258096538021482,"endowment":3.258096538021482,"self_citation_contribution":0.4887144807032224,"citation_network_contribution":0.0,"self_endowment_contribution":0.4887144807032224,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":25,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9522,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":98931,"name":"Andrew Stokes","orcid":"0000-0002-8502-3636","position":1,"is_corresponding":false},{"id":883317,"name":"Hélène E. Aschmann","orcid":"0000-0003-1234-4321","position":2,"is_corresponding":false},{"id":748170,"name":"Ruijia Chen","orcid":"0000-0002-2759-9290","position":3,"is_corresponding":false},{"id":894567,"name":"Shelley DeVost","orcid":null,"position":4,"is_corresponding":false},{"id":275472,"name":"Mathew V. Kiang","orcid":"0000-0001-9198-150X","position":5,"is_corresponding":false},{"id":29204,"name":"Suneil K. Koliwad","orcid":"0000-0002-7367-1054","position":6,"is_corresponding":false},{"id":297925,"name":"Alicia R. Riley","orcid":"0000-0002-3341-6892","position":7,"is_corresponding":false},{"id":106142,"name":"M. Maria Glymour","orcid":"0000-0001-9644-3081","position":8,"is_corresponding":false},{"id":74900,"name":"Kirsten Bibbins‐Domingo","orcid":"0000-0002-8962-0622","position":9,"is_corresponding":false},{"id":404146,"name":"Yea‐Hung Chen","orcid":"0000-0002-7949-0692","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T00:24:37.429628Z","pmid":"35832865","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}