Kentucky's Covid-19 death rate lower than U.S. average when adjusted for health conditions and average ages in the states

Rates before (L) and after (R) adjustment for conditions; click image to enlarge

By Melissa Patrick
Kentucky Health News

Now that Covid-19 has gone beyond the pandemic phase to the endemic phase, how did Kentucky handle the pandemic? A study has found that Kentucky's coronavirus infection rate and Covid-19 death rate were above the national averages, but the death rate was below average when states' rates were adjusted for their residents' health conditions and average age.

“It is encouraging that the authors found that Kentucky outperformed in preventing Covid-19 deaths relative to the health status of our population," state Health Commissioner Steven Stack said in an email response to Kentucky Health News's request for comment.

"It’s important we remain mindful, however, that more than 18,000 Kentuckians have died from Covid-19 and that our shared journey has been difficult," said Stack, a physician. "I am grateful, though, that Kentuckians confronted this threat together and together have overcome it while showing kindness and caring towards each other." 

The research, published in The Lancet, a British medical journal, aimed to compare the states' successes in mitigating the impact of Covid-19. 

To compare state data, the researchers, led by Thomas Bollyky of the Council on Foreign Relations and Emma Castro of the Institute for Health Metrics and Evaluation at the University of Washington, standardized the Covid-19 infection rates for population density and the death rates for age and the prevalence of comorbidities, which is the existence of more than one disease or other health condition at the same time. 

They found that Kentucky's unadjusted Covid-19 death rate from January 2020 through July 2022 was 472 deaths for every 100,000 residents. But after adjusting for age and comorbidities, the rate was only 341 deaths per 100,000 population—lower than the national rate of 372. 

The state with the lowest adjusted death rate was Hawaii (147 per 100,000 residents) and the highest was Arizona (581 per 100,000).

After adjusting the rates, the researchers looked at the effect of states' characteristics before the pandemic began, such as education levels, health spending per person, state mitigation policies, and individual factors such as vaccine coverage and employment. 

Income, education, vaccines, personal trust, preventive mandates cited

The researchers found that states with low poverty rates, higher education rates and a greater share of people expressing interpersonal trust—defined as the trust that people report having in one another—had lower infection and death rates. 

States that offered access to quality health care also had fewer Covid-19 deaths and infections, but states with higher public-health spending and more public-health personnel per capita did not. 

A state's use of protective mandates were associated with lower infection rates, as were mask use, lower mobility and higher vaccination rates. And, higher vaccination rates were associated with lower death rates.

What about politics? The political affiliation of a state's governor was not associated with lower infection or death rates, but worse outcomes were associated with the proportion of a state's voters who voted for then-President Donald Trump in 2020.

Kentucky was a strong Trump state and has a Republican legislature, but has a Democratic governor, Andy Beshear, who imposed mask mandates and limitations on business activity and public gatherings.

States that did not close businesses, such as restaurants, had higher infection rates, the researchers found, based on unemployment rates: "On average, 1,574 additional infections per 10,000 population were associated in states with a one percentage point increase in the employment rate."

State policies were a factor, the researchers wrote: "States' struggles in the Covid-19 pandemic were not inevitable. The nearly four-fold differences that existed across states in Covid-19 death rates, even when standardized for factors such as age and comorbidities, suggest that lower death rates were achievable." 

The researchers added that while "Covid-19 magnified the polarization and persistent social, economic, and racial inequities that already existed across U.S. society . . . the next pandemic threat need not do the same. U.S. states that mitigated those structural inequalities, deployed science-based interventions such as vaccination and targeted vaccine mandates, and promoted their adoption across society, were able to match the best-performing nations in minimizing Covid-19 death rates. These findings could contribute to the design and targeting of clinical and policy interventions to facilitate better health outcomes in future crises."