Abstract
OBJECTIVES: Place-based disadvantage indices have been used to assess health disparities and allocate funding and health resources. We assessed excess mortality in California during the COVID-19 pandemic by Healthy Places Index (HPI) quartile, a disadvantage index used by the California Department of Public Health to structure COVID-19 response efforts. METHODS: We estimated expected deaths from all causes during the COVID-19 pandemic by fitting a quasi-Poisson regression model to actual deaths that occurred from 2014 through 2019. We estimated ranges of excess deaths by calculating differences between actual deaths and (1) the average expected number of deaths and (2) the upper bound of the 95% prediction interval. The percentage of excess deaths equaled the number of excess deaths divided by the corresponding threshold. We reported estimates overall and across demographic groups, stratified by HPI quartile; quartile 4 indicated communities with the most advantaged social and environmental conditions. RESULTS: From February 2020 through April 2022, the number of excess deaths in California ranged from 81 245 to 107 806, with 93 309 deaths attributed to COVID-19. The number of excess deaths decreased across quartiles, from 27 924 to 35 615 (20.5%-28.0%) in HPI quartile 1 to 7757 to 14 477 (4.6%-9.2%) in HPI quartile 4. The Hispanic or Latine population had a disproportionate percentage of excess deaths across all quartiles, whereas American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Pacific Islander, and White (all non-Hispanic) populations had percentage excess death estimates in quartile 2 that were similar to or higher than in quartile 1. CONCLUSIONS: Health policies should supplement the use of place-based disparity measures with other measures that support groups at high risk for adverse health outcomes residing in more socially and environmentally advantaged communities.