Using Public Funeral and Obituary Listings to Identify Spikes in Excess Mortality in One Appalachian County.

Introduction: Delays (10-22 months) in availability of official state and county-level mortality data could have significant public health consequences. The COVID-19 pandemic illuminated the need for health officials to access timely death data to identify unexpected increases in mortality in their communities. Purpose: The purpose of this study is to determine if funeral home listings and/or newspaper obituaries could help identify excess mortality on the local level, prior to the availability of official death records. Methods: To calculate excess mortality, four years (2017-2020) of data were collected from three sources: the state health department, online funeral home listings, and newspaper obituaries, all from Washington County, Tennessee. Simple linear regression was used to predict number of expected deaths by month for 2020 using 2017, 2018, and 2019 reported deaths, by data source. The percent difference of actual 2020 deaths from the expected deaths was then calculated by month and compared for each data source. Results: Official COVID-19 state-reported death data accounted for only 50% of excess mortality estimated in 2020. Nearly 100 excess deaths occurred before the first reported death due to COVID-19. Trends in the percent difference between actual and expected funeral home listings and newspaper obituaries followed similar patterns as percent differences in actual v. expected state-reported mortality data. Implications: Had funeral home listings and newspaper obituaries been used to identify excess mortality, health officials would have seen increases in mortality nearly five months prior to the first identified COVID-19 death. These publicly available tools could prove valuable to local health officials as an "early warning" sign of excess mortality.