PLACE OF DEATH: "Although older individuals are much more likely to die from COVID-19, younger individuals are more likely to die at home from the disease.".

• Author: Wedenoja, Leigh
• Position: MEDICINE & HEALTH

MORE THAN TWO YEARS into the pandemic, the U.S. has passed the tragic threshold of 1,000,-000 deaths due to COVID-19. We have reached this terrible milestone still working to understand both how the virus functions from a medical and scientific perspective and how the pandemic has affected and will continue to affect our lives, communities, and economy in a broader sense. Looking back to the first year of the pandemic and the detailed data on COVID-19 deaths now available for that year can provide valuable insight as we move forward.

In 2020 alone, the Centers for Disease Control and Prevention reported 350,831 deaths in which COVID-19 was the underlying cause of death listed on the death certificate; of those deaths, 19,413 occurred in the decedent's home. Throughout the COVID-19 pandemic, public health practitioners and researchers have focused heavily on the role that hospitals and hospital capacity plays in who dies or has serious complicatioas from COVID-19, but substantially less attention has been paid to people who die at home without seeking medical care. In some cases, dying at home is a conscious choice; people have chosen to die at home for the increased comfort that it affords over being hooked up to machines in the hospital. Other COVID-19 deaths in the home may be driven by external factors, including a lack of access to medical care due to distance, lack of capacity in hospitals, a lack of health insurance, or postponing seeking care until it is too late.

Data for this research is generated from death certificates contained in the Mortality Multiple Cause Files and in CDC WONDER. Death certificates document and categorize one of seven places of death: hospital (inpatient, outpatient, or dead-on arrival), nursing home, hospice, decedent's home, or other place. They also include the demographic characteristics of decedents and the cause or causes of death.

The risk of dying from COVID-19 increases substantially with age. The mortality rate for the disease was 893.8 deaths per 100,000 people among those 75 years and older, which was over six times higher than the rate for persons 50-74 years old (135.0) and over 120 times higher than the rate for persons under 50 years old (7.4).

Although older individuals are much more likely to die from COVID-19, younger individuals are more likely to die at home from the disease. Some 12.7% of adults younger than 50 years old who died from COVID-19 died at home. By comparison, six percent of adults aged 50-74 years old and 4.7% of adults 75 years and older died at home.

One potential explanation for the high percentage of young adults dying at home is that they did not take COVID-19 seriously. Many also may have foregone medical treatment for the disease because they underestimated the lethality of the virus and overestimated their ability to ward off serious illness or were initially reassured by doctors that they were lowrisk and did not seek additional care as a result.

It also is possible that some young adults avoided seeking medical help because they did not have health insurance. The Census Bureau estimates that more than 15% of people 19-34 years old are uninsured. The Health Resources and Services Administration COVID-19 Uninsured Program reimburses...