See where Ohio’s death rates increased most during COVID-19; urban areas like Cleveland

CLEVELAND, Ohio – The pandemic has hit Ohio hard.

Deaths from all causes shot up 16.1% in 2020 as the pandemic took off and then another 2.7% on top of that in 2021. In those two years, about 45,000 more Ohioans died than what would have been expected if pre-pandemic patterns had continued.

After a recent report found that Ohio had one of the highest increased mortality rates in the country, cleveland.com dug deeper to the county level using three points of reference – the last half of 2019 before the pandemic, the last half of 2020 before wide introduction of vaccines (only available to a few before the end of 2020), and the last half of 2021 after all Ohio adults were eligible for vaccines.

We found a geographic divide, with sharper increases in deaths in Ohio’s smaller counties and less severe numbers in the urban areas such as Cuyahoga County. But trends extended beyond geography to vaccinations and even politics.

Rural vs. urban

Death rates went up faster in Ohio’s rural areas, and the gap in death rates between rural and urban areas only widened in 2021 after vaccines became widely available.

Half of the 10 counties with the highest mortality rates are among the most rural counties in the state. The most rural county in Ohio, Vinton County, had the highest mortality rate increase at 65.4% from 2019 to 2022.

The Census Bureau classifies counties as urban or rural based on the number and size of population centers. In Ohio, 73 counties are considered rural; 15 as urban.

The mortality rate increase from 2019 to 2021 in Ohio rural counties as a group was 33%, 10 percentage points higher than the urban counties, which include Hamilton, Franklin, and Cuyahoga.

In short, while the larger urban areas have lost more people by sheer numbers, rural counties lost a larger percentage of their communities each year.

This became more pronounced in year two of the pandemic.

In 2020 – ahead of vaccines – the mortality rate increase in both types of counties was similar. It was 26.7% in rural areas and 24.39% in urban counties.

Ohio adults of all ages became eligible for vaccines during the spring of 2021. Looking at the mortality data from the second half of 2021, urban counties saw a decrease of 1.89% from the second half of 2020, while rural areas increased another 5.24%.

The gap becomes even wider if you match the demographics of rural counties to urban counties. Ohio’s rural counties are predominately white, as most of the minority population is located in large metropolitan areas.

Among white people in Ohio, mortality rates decreased from 2020 to 2021 in urban counties by 2.4%, while at the same time, the rate for white people in rural counties increased by 5.4%.

From 2019 to 2021, the total mortality rate increase was 20.4% for urban white Ohioans compared to 33% for rural white Ohioans.

In a study released earlier this year, white Americans saw the largest continued drop in life expectancy, with an additional 0.34 years shaved off, almost single-handedly contributing to the U.S. drop of 0.39 years.

Black and Hispanic communities made modest gains after COVID-19 slashed their life expectancy by over three years in 2020.

Introducing Vaccines

By July 2021, most adults were able to be fully vaccinated to stave off the coronavirus. Only a tiny fraction of all deaths and hospitalizations since late last year have involved fully vaccinated Ohioans.

But vaccination rates varied widely across Ohio.

Only 33 of Ohio’s 88 counties had more than half of their residents fully vaccinated by the end of 2021. All 15 urban counties, including the biggest areas around Cleveland, Columbus, and Cincinnati, are included in the top 33, with eight of the top 10 vaccinated counties being urban counties. The vaccination rates in Ohio’s three largest counties ranged from 60.5% to 63.6%.

With varied adoption of the vaccine, changes in the death rates followed.

Some of the least vaccinated counties have seen the largest increases in mortality rates. Coshocton (38.9% vaccinated, 52.1% mortality increase from 2019 to 2021), Vinton (38.9% vaccinated, 65.4% mortality increase), Hardin (38.2% vaccinated, 58.8% mortality increase), and Adams (34.3% vaccinated, 50.3% mortality increase) top both lists.

These counties also accounted for some of the highest spikes in mortality rates from 2020 to 2021. Coshocton increased by 18.5%, Vinton by 27.6%, Hardin by 27.2%, and Adams by 32.3%.

One outlier to this is Mercer County, which ranks as the sixth least vaccinated county but No. 1 for decreased mortality from 2020 to 2021. Mercer County saw a 16.4% decrease in mortality during this time, following a 50.5% increase from the start of the pandemic.

The other is Holmes County. The predominately Amish county has the lowest vaccination rate in the state and one of the lowest increases in mortality, suggesting that the community with minimal outsider interactions may have helped prevent widespread death.

Politicizing prevention

A 2022 study found that political affiliation played a significant part in whether someone would get the vaccine among surveyed Americans. Republican voters and anti-vaxxers would cite mistrust of the government and “Big Pharma” as reasons for not receiving the vaccine.

Anti-vaccine leanings also had higher correlations with more conservative social attitudes and higher approval ratings for President Donald Trump. Coupled with disinformation spreading on social media on vaccine intentions and efficacies, counties that voted Republican versus Democrat in the 2020 election cycle showed another divide.

In the 81 Ohio counties that voted for Trump, the death rate in the second half of 2021 – after vaccines were available for Ohio adults of any age – increased by 32.14% over the second half of 2019 ahead of the pandemic.

Yet, in the seven “blue” counties that went for Joe Biden – including six of the largest counties in Ohio plus Athens County – deaths increased by only 19.15% over the same period.

Additionally, from the second half of 2020 to the same months in 2021, mortality rates decreased by 3.2% in blue counties while increasing an additional 3.74% in red counties.

In Ohio overall, the greater percentage of a county that voted for Donald Trump in the 2020 presidential election, the lower the vaccination rate.

All things considered

Explore the map below to dive deeper into how each category could be related to the others. Use the buttons at the top of the map to compare mortality rates from 2019 to 2021 to whether the county is rural or urban, the vaccinated population, and the 2020 election results.

Some mobile readers may need to visit this link to see the map below and all other charts and maps within this story.