The United States has the dubious distinction of suffering the highest COVID-19 mortality rate among the world’s high-income countries. But that national average — 372 deaths per 100,000 people as of last summer — hides the fact that pandemic outcomes differed greatly from state to state.
In a comparison that controlled for demographic differences between states, Arizona’s COVID-19 mortality rate of 581 deaths per 100,000 residents was almost four times higher than Hawaii’s, where there were 147 deaths per 100,000 residents. Death rates in the hardest-hit U.S. states resembled those of countries with no healthcare infrastructure whatever. States that fared best had rates on a par with countries such as Australia, New Zealand and South Korea, which worked zealously to keep their pandemic death tolls low.
What accounts for these wide disparities? A new study offers some intriguing answers.