{"id":"https://openalex.org/W7167628898","doi":"https://doi.org/10.3389/fpubh.2026.1975691","title":"Large-scale assessment of socioeconomic, demographic, and health system structures with US county excess mortality, 2020\u20132024","display_name":"Large-scale assessment of socioeconomic, demographic, and health system structures with US county excess mortality, 2020\u20132024","publication_year":2026,"publication_date":"2026-11-11","ids":{"openalex":"https://openalex.org/W7167628898","doi":"https://doi.org/10.3389/fpubh.2026.1975691","pmid":"https://pubmed.ncbi.nlm.nih.gov/42465911","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13370557"},"language":"en","primary_location":{"id":"doi:10.3389/fpubh.2026.1975691","doi":"https://doi.org/10.3389/fpubh.2026.1975691","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fpubh.2026.1975691","pdf_url":null,"source":{"id":"https://openalex.org/S2595931848","display_name":"Frontiers in Public Health","issn_l":"2296-2565","issn":["2296-2565"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Public Health","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.3389/fpubh.2026.1975691","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5019080704","display_name":"Michael Levitt","orcid":"https://orcid.org/0000-0002-8414-7397","observed_orcids":["https://orcid.org/0000-0002-8414-7397"]},"institutions":[{"id":"https://openalex.org/I4210137306","display_name":"Stanford Medicine","ror":"https://ror.org/03mtd9a03","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210137306","https://openalex.org/I97018004"]},{"id":"https://openalex.org/I97018004","display_name":"Stanford University","ror":"https://ror.org/00f54p054","country_code":"US","type":"education","lineage":["https://openalex.org/I97018004"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Michael Levitt","raw_affiliation_strings":["Department of Medicine , Stanford University School of Medicine , Stanford , California , USA;"],"raw_orcid":"https://orcid.org/0000-0002-8414-7397","affiliations":[{"raw_affiliation_string":"Department of Medicine , Stanford University School of Medicine , Stanford , California , USA;","institution_ids":["https://openalex.org/I4210137306","https://openalex.org/I97018004"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5124889044","display_name":"Ben Marten","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210137306","display_name":"Stanford Medicine","ror":"https://ror.org/03mtd9a03","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210137306","https://openalex.org/I97018004"]},{"id":"https://openalex.org/I97018004","display_name":"Stanford University","ror":"https://ror.org/00f54p054","country_code":"US","type":"education","lineage":["https://openalex.org/I97018004"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Ben Marten","raw_affiliation_strings":["Department of Structural Biology , Stanford University School of Medicine , Stanford , CA 94305 , USA;","Mortality.Watch , St. Petersburg , Florida , USA;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Structural Biology , Stanford University School of Medicine , Stanford , CA 94305 , USA;","institution_ids":["https://openalex.org/I4210137306","https://openalex.org/I97018004"]},{"raw_affiliation_string":"Mortality.Watch , St. Petersburg , Florida , USA;","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5030616543","display_name":"Gal Oren","orcid":"https://orcid.org/0000-0002-8831-5423","observed_orcids":["https://orcid.org/0000-0002-8831-5423"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Gal Oren","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5070446713","display_name":"John P. A. Ioannidis","orcid":"https://orcid.org/0000-0003-3118-6859","observed_orcids":["https://orcid.org/0000-0003-3118-6859"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"John P. A. Ioannidis","raw_affiliation_strings":[],"raw_orcid":"https://orcid.org/0000-0003-3118-6859","affiliations":[]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":{"value":3150,"currency":"CHF","value_usd":3801},"apc_paid":{"value":3150,"currency":"CHF","value_usd":3801},"fwci":2.643,"has_fulltext":true,"cited_by_count":1,"citation_normalized_percentile":{"value":0.82657048,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":91,"max":95},"biblio":{"volume":"14","issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10410","display_name":"COVID-19 epidemiological studies","score":0.8817999958992004,"subfield":{"id":"https://openalex.org/subfields/2611","display_name":"Modeling and Simulation"},"field":{"id":"https://openalex.org/fields/26","display_name":"Mathematics"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},"topics":[{"id":"https://openalex.org/T10410","display_name":"COVID-19 epidemiological studies","score":0.8817999958992004,"subfield":{"id":"https://openalex.org/subfields/2611","display_name":"Modeling and Simulation"},"field":{"id":"https://openalex.org/fields/26","display_name":"Mathematics"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T10235","display_name":"Health disparities and outcomes","score":0.06449999660253525,"subfield":{"id":"https://openalex.org/subfields/3306","display_name":"Health"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12935","display_name":"Healthcare Systems and Public Health","score":0.006899999920278788,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/socioeconomic-determinants-of-health","display_name":"socioeconomic determinants of health","score":0.7940000295639038},{"id":"https://openalex.org/keywords/county-level-mortality-rates","display_name":"county-level mortality","score":0.6129999756813049},{"id":"https://openalex.org/keywords/health-system-resources","display_name":"health system resources","score":0.6010000109672546},{"id":"https://openalex.org/keywords/uninsured-adults","display_name":"uninsured adults","score":0.6230000257492065},{"id":"https://openalex.org/keywords/college-attainment","display_name":"college attainment","score":0.8199999928474426},{"id":"https://openalex.org/keywords/income","display_name":"income","score":0.5870000123977661},{"id":"https://openalex.org/keywords/race-and-ethnicity","display_name":"race and ethnicity","score":0.6589999794960022},{"id":"https://openalex.org/keywords/health-insurance","display_name":"health insurance","score":0.5759999752044678},{"id":"https://openalex.org/keywords/housing","display_name":"housing","score":0.37400001287460327},{"id":"https://openalex.org/keywords/employment","display_name":"employment","score":0.8289999961853027},{"id":"https://openalex.org/keywords/health-disparities","display_name":"health disparities","score":0.5090000033378601},{"id":"https://openalex.org/keywords/ecological-analysis","display_name":"ecological analysis","score":0.37700000405311584},{"id":"https://openalex.org/keywords/us-counties","display_name":"United States counties","score":0.3370000123977661}],"concepts":[{"id":"https://openalex.org/C147077947","wikidata":"https://www.wikidata.org/wiki/Q1515895","display_name":"Socioeconomic status","level":3,"score":0.7634000182151794},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.6069999933242798},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.4645000100135803},{"id":"https://openalex.org/C27574286","wikidata":"https://www.wikidata.org/wiki/Q320723","display_name":"Variables","level":2,"score":0.44909998774528503},{"id":"https://openalex.org/C89623803","wikidata":"https://www.wikidata.org/wiki/Q12184","display_name":"Pandemic","level":5,"score":0.42730000615119934},{"id":"https://openalex.org/C159744936","wikidata":"https://www.wikidata.org/wiki/Q1126730","display_name":"Spearman's rank correlation coefficient","level":2,"score":0.3921000063419342},{"id":"https://openalex.org/C205649164","wikidata":"https://www.wikidata.org/wiki/Q1071","display_name":"Geography","level":0,"score":0.3849000036716461},{"id":"https://openalex.org/C117220453","wikidata":"https://www.wikidata.org/wiki/Q5172842","display_name":"Correlation","level":2,"score":0.3837999999523163},{"id":"https://openalex.org/C2780084366","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demographics","level":2,"score":0.3612000048160553},{"id":"https://openalex.org/C55078378","wikidata":"https://www.wikidata.org/wiki/Q1136628","display_name":"Pearson product-moment correlation coefficient","level":2,"score":0.3287000060081482},{"id":"https://openalex.org/C2780892066","wikidata":"https://www.wikidata.org/wiki/Q1591167","display_name":"Household income","level":2,"score":0.2849999964237213},{"id":"https://openalex.org/C121272143","wikidata":"https://www.wikidata.org/wiki/Q17021791","display_name":"Health indicator","level":3,"score":0.2849000096321106},{"id":"https://openalex.org/C2250968","wikidata":"https://www.wikidata.org/wiki/Q1512929","display_name":"Health equity","level":3,"score":0.26420000195503235},{"id":"https://openalex.org/C78491826","wikidata":"https://www.wikidata.org/wiki/Q3045352","display_name":"Social determinants of health","level":3,"score":0.2621999979019165},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.25450000166893005},{"id":"https://openalex.org/C152877465","wikidata":"https://www.wikidata.org/wiki/Q208042","display_name":"Regression analysis","level":2,"score":0.2533000111579895}],"mesh":[],"locations_count":5,"locations":[{"id":"doi:10.3389/fpubh.2026.1975691","doi":"https://doi.org/10.3389/fpubh.2026.1975691","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fpubh.2026.1975691","pdf_url":null,"source":{"id":"https://openalex.org/S2595931848","display_name":"Frontiers in Public Health","issn_l":"2296-2565","issn":["2296-2565"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Public Health","raw_type":"journal-article"},{"id":"doi:10.2139/ssrn.7305715","doi":"https://doi.org/10.2139/ssrn.7305715","is_oa":true,"landing_page_url":"https://doi.org/10.2139/ssrn.7305715","pdf_url":"https://doi.org/10.2139/ssrn.7305715","source":{"id":"https://openalex.org/S4210172589","display_name":"SSRN Electronic Journal","issn_l":"1556-5068","issn":["1556-5068"],"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1318003438","host_organization_name":"RELX Group (Netherlands)","host_organization_lineage":["https://openalex.org/I1318003438"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"posted-content"},{"id":"doi:10.64898/2026.07.04.26357291","doi":"https://doi.org/10.64898/2026.07.04.26357291","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.07.04.26357291","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/07/07/2026.07.04.26357291.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},{"id":"pmid:42465911","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42465911","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"medRxiv : the preprint server for health sciences","raw_type":"Journal Article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13370557","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13370557/","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"medRxiv","raw_type":"Text"}],"best_oa_location":{"id":"doi:10.3389/fpubh.2026.1975691","doi":"https://doi.org/10.3389/fpubh.2026.1975691","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fpubh.2026.1975691","pdf_url":null,"source":{"id":"https://openalex.org/S2595931848","display_name":"Frontiers in Public Health","issn_l":"2296-2565","issn":["2296-2565"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Public Health","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.8048999905586243,"display_name":"Good health and well-being"},{"id":"https://metadata.un.org/sdg/10","score":0.7307999730110168,"display_name":"Reduced inequalities"}],"study_designs":[],"awards":[{"id":"https://openalex.org/G862003413","display_name":null,"funder_award_id":"N00014-24-1-2687","funder_id":"https://openalex.org/F4320337345","funder_display_name":"Office of Naval Research"},{"id":"https://openalex.org/G9000859646","display_name":"Data science tools to identify robust exposure-phenotype associations for precision medicine","funder_award_id":"R01ES032470","funder_id":"https://openalex.org/F4320337361","funder_display_name":"National Institute of Environmental Health Sciences"},{"id":"https://openalex.org/G9000889369","display_name":"Emergent Properties of Complex Systems: From Atoms to Macromolecules; from Humans to Societies","funder_award_id":"R35GM122543","funder_id":"https://openalex.org/F4320337354","funder_display_name":"National Institute of General Medical Sciences"}],"funders":[{"id":"https://openalex.org/F4320332161","display_name":"National Institutes of Health","ror":"https://ror.org/01cwqze88"},{"id":"https://openalex.org/F4320337345","display_name":"Office of Naval Research","ror":"https://ror.org/00rk2pe57"},{"id":"https://openalex.org/F4320337354","display_name":"National Institute of General Medical Sciences","ror":"https://ror.org/04q48ey07"},{"id":"https://openalex.org/F4320337361","display_name":"National Institute of Environmental Health Sciences","ror":"https://ror.org/00j4k1h63"}],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7167628898.pdf","grobid_xml":"https://content.openalex.org/works/W7167628898.grobid-xml"},"referenced_works_count":37,"referenced_works":["https://openalex.org/W1607157500","https://openalex.org/W1987971958","https://openalex.org/W1999096098","https://openalex.org/W2016381774","https://openalex.org/W2040567513","https://openalex.org/W2042386526","https://openalex.org/W2075839138","https://openalex.org/W2083776874","https://openalex.org/W2144206754","https://openalex.org/W2327332664","https://openalex.org/W2332787986","https://openalex.org/W2401468526","https://openalex.org/W2413204736","https://openalex.org/W2579779633","https://openalex.org/W2732372625","https://openalex.org/W2810551427","https://openalex.org/W2922179416","https://openalex.org/W2970641574","https://openalex.org/W3004813438","https://openalex.org/W3020264722","https://openalex.org/W3024439491","https://openalex.org/W3034285292","https://openalex.org/W3037655340","https://openalex.org/W3087287908","https://openalex.org/W3092695915","https://openalex.org/W3118245249","https://openalex.org/W3120867737","https://openalex.org/W3121159199","https://openalex.org/W3121472717","https://openalex.org/W3135774079","https://openalex.org/W3162864803","https://openalex.org/W4389128604","https://openalex.org/W4399164460","https://openalex.org/W4400582006","https://openalex.org/W4406887355","https://openalex.org/W4412161610","https://openalex.org/W7139016511"],"related_works":["https://openalex.org/W7220845576","https://openalex.org/W3162864803","https://openalex.org/W4417115954","https://openalex.org/W4390906135","https://openalex.org/W3108294930","https://openalex.org/W4213288449","https://openalex.org/W4323663113","https://openalex.org/W4402545485","https://openalex.org/W7133128874","https://openalex.org/W4413127836"],"abstract_inverted_index":{"Socioeconomic,":[0],"demographic,":[1],"and":[2,40,92,113,129,137,142,166,175,193,209,215,241,249],"health":[3,41,181,246],"system":[4,182,247],"structures":[5],"may":[6],"have":[7,16],"shaped":[8],"the":[9,50,152,197,213,220,225],"impact":[10],"of":[11,24,32,80,125,163,168,180,191],"COVID-19,":[12],"but":[13,133,219],"past":[14],"analyses":[15,234],"examined":[17,22],"few":[18],"factors.":[19],"We":[20],"systematically":[21],"correlates":[23],"COVID-era":[25],"excess":[26,60,252],"mortality,":[27,253],"considering":[28],"2,745":[29],"county-level":[30],"variables":[31,81,126,157,171,183,217],"demography,":[33],"race/ethnicity,":[34],"income,":[35],"insurance,":[36],"education,":[37],"employment,":[38],"housing,":[39],"systems.":[42],"Pearson":[43],"correlation":[44,87,221],"coefficients":[45],"(CCs)":[46],"were":[47,70,103,121],"obtained":[48],"for":[49,62,105,123],"most":[51,198],"recent":[52,199],"available":[53,200],"pre-pandemic":[54],"values":[55],"against":[56],"population-weighted":[57],"age-standardized":[58],"county":[59],"death":[61],"each":[63],"year":[64],"from":[65],"2020":[66,128],"to":[67,173,189,228],"2024.":[68],"Variables":[69],"grouped":[71],"by":[72],"meaning":[73],"into":[74],"11":[75],"semantic":[76],"super-clusters.":[77,177],"Overall,":[78,231],"24.1%":[79],"reached":[82,94,184],"at":[83],"least":[84,118],"a":[85],"moderate":[86,119],"level":[88],"(|CC|":[89,97],">":[90,98,160,186],"0.30)":[91],"7.4%":[93],"strong":[95],"correlations":[96,102,120,211],"0.45).":[99],"The":[100,145],"strongest":[101],"observed":[104],"poverty":[106],"share":[107],"(CC":[108],"+0.64),":[109],"college":[110],"attainment":[111],"(\u22120.62),":[112],"high":[114],"income":[115],"(\u22120.61).":[116],"At":[117],"seen":[122],"11.4%":[124],"in":[127,131,139,147,151],"14.8%":[130],"2021,":[132],"only":[134],"3.3,":[135],"1.3,":[136],"4.1%":[138],"2022,":[140],"2023,":[141],"2024,":[143],"respectively.":[144],"concentration":[146],"2020\u20132021":[148],"was":[149],"sharpest":[150],"under-65":[153],"population.":[154],"Of":[155],"656":[156],"with":[158,224,251],"|CC|":[159,185],"0.30,":[161,187],"295":[162],"454":[164],"moderate-band":[165],"200":[167],"202":[169],"strong-band":[170],"belonged":[172],"demographic":[174,194],"socioeconomic":[176,192,239],"Only":[178],"10%":[179],"compared":[188],"42%":[190],"variables.":[195],"Using":[196],"value":[201],"until":[202],"2023":[203],"or":[204],"2015,":[205],"different":[206],"population":[207],"weighting,":[208],"Spearman":[210],"left":[212],"direction":[214],"leading":[216],"unchanged,":[218],"magnitudes":[222],"scaled":[223],"weight":[226],"given":[227],"large":[229],"counties.":[230],"these":[232],"ecological":[233],"suggest":[235],"stronger":[236],"relationships":[237],"between":[238,244],"structure":[240,248],"demographics":[242],"than":[243],"baseline":[245],"supply":[250],"especially":[254],"during":[255],"2020\u20132021.":[256]},"counts_by_year":[{"year":2026,"cited_by_count":1}],"updated_date":"2026-11-12T12:28:57.059296","created_date":"2026-07-08T00:00:00"}