All-Cause Mortality Increased From 2020 to 2021 Nationwide

THURSDAY, April 10, 2025 (HealthDay News) — All-cause mortality increased in 2020 to 2021 nationwide, with a slower increase in Medicaid expansion states, according to a study published online April 3 in the American Journal of Public Health.

Xuesong Han, Ph.D., from the American Cancer Society in Atlanta, and colleagues examined the association of state Medicaid expansion status with mortality changes during the COVID-19 pandemic. Using 2018 to 2022 mortality surveillance data, deaths were identified at ages 20 to 64 years in 3,142 U.S. counties. For each county, age-adjusted mortality rates were calculated. Changes in mortality rates pre- and post-COVID-19 pandemic onset were calculated in Medicaid expansion states relative to nonexpansion states, with adjustment for county sociodemographic factors and state COVID-19 vaccination rates.

The researchers found that in 2020 to 2021, all-cause mortality rates increased nationwide, with a slight decrease in 2022. Medicaid expansion states had a slower increase, resulting in a net decrease from 2018-2019 to 2021-2022 of 31.8 per 100,000 person-years associated with Medicaid expansion. The largest decrease was seen for deaths from heart disease or liver disease and was seen across sex, age, and race subpopulations.

“This research is important because many people experienced employment disruptions during the pandemic, which, in addition to loss of household income, also led to loss of employment-based health insurance coverage,” Han said in a statement. “Medicaid expansion under the Affordable Care Act could improve access to care and reduce health disparities during the public health emergency.”

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