On second look, Michigan’s COVID death rate wasn’t so bad, study finds

• Michigan fared better than previously thought in COVID death rates, when state residents’ age and health are considered 
• Helping the state was its adherence to policies; hurting it was its distrust in science
• Michigan’s strict pandemic policies may have saved lives but slowed the economy, the study found

Michigan was hit hard by COVID-19, there’s not much doubt of that. Based on population, the state suffered the 10th worst death rate of any state in the nation, leading to some of the criticism the Whitmer administration faced for its handling of the pandemic.

But a comprehensive, state-by-state study suggests that standard mortality analytics don’t always tell the full story.

When Michigan’s older and less healthy population is factored in, the state actually fared better than most other states in keeping its residents alive.

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The study, published in the peer-reviewed medical journal The Lancet, found that Michigan’s death rate, once adjusted, was the nation’s 16th best. 

“That's a really big shift,” Joseph Dieleman, one of the researchers, told Bridge Michigan. “It speaks to the population of Michigan being older and a little bit less healthy.” 

The aim of the research, published last week, was to dive deeper into the social, economic, racial and political factors that helped shape the nation’s response to the pandemic and the vast differences in infections and death across states. 

Funded by the Bill & Melinda Gates Foundation, the study involved dozens of researchers associated with the Institute for Health Metrics and Evaluation, a population health research organization based at the University of Washington School of Medicine.

There were plenty of takeaways, including some surprises:  

• Adjusted for age and health, Arizona had the nation’s worst death rate, followed by the District of Columbia and New Mexico. At the other end, Hawaii had the lowest adjusted death rate, followed by New Hampshire and Maine.
• At points in the pandemic, Republican leaders in open-for-business states like Florida and Texas stood diametrically from Democratic leaders in places like California and Michigan, which kept bars, restaurants and many other businesses locked down to protect  residents from deadly infection. But the study found no association between the political party of a state’s governor and death rates.  
• That’s not to say politics played no role. Indeed, one critical factor in infection and death rates was the share of people in a state who voted for Donald Trump in the 2020 presidential election. Other leading factors included poverty and education levels.  
• There were, however, economic trade-offs for states that set strict masking and business policies: They helped reduce infections but also slowed economies and academic learning. “Our study suggests that the policy mandates and protective behaviours adopted in this pandemic were effective in reducing SARS-CoV-2 infections but might have been associated with employment and educational trade-offs,” the study said. 

Older, sicker and more vulnerable 

Researchers pointed out that the quality of a state’s health system was important but only to the extent that residents took advantage of it to get vaccinated and receive early treatment for infection. 

Some states performed well at first glance, but less so when adjusted for their relative youth. 

Dieleman, an associate professor at the Institute for Health Metrics and Evaluation, pointed to Utah as an illustration. 

Judging solely by population, Utah had the third lowest death rate in the nation. But the state has a relatively young and healthy population —  its average age is under 32 years old, 10 years younger than Florida, for example. 

When researchers factored in Utah’s youth and good health, COVID’s outsized toll on the state became clear: Utah’s adjusted death rate dropped  to 45th compared among other states and the District of Columbia.

Michigan flipped in the opposite direction. 

Its 438 deaths for every 100,0000 people made it 10th worst among states (11th worst when the District of Columbia is included.) But adjusted for age and health, Michigan would have recorded 326 deaths among every 100,000 people, according to the research.

Hawaii and New Hampshire, which have less poverty, inequality, and posted high vaccination rates, had the lowest death rates when adjusted for age and comorbidities — with 147 and 215 deaths per 100,000, respectively. Arizona and Washington, D.C. had the highest adjusted death rates — 581 and 526 deaths per 100,000, respectively. 

Researchers ranked Michigan as 10th among states and the District of Columbia for most restrictive COVID policies.

On a national level, decisions to keep restaurants closed and maintain higher levels of masking appeared to have saved lives but cost jobs. Michigan, which had one of the highest jobless rates in the first months of the pandemic, ranked 42nd overall in terms of recovering jobs, according to The Lancet.   

On average, for every percentage point increase in employment, states reported 1,574 additional infections per 10,000 population, the researchers calculated.

“The question is could you buy your economy by having more infections … more mortality?” Dieleman said in video comments released along with the report.

Researchers found no correlation between a state’s policies and its gross domestic product. Michigan, for instance, had a stronger-than-average output compared to other states, Dieleman told Bridge.

There were other notable outcomes, too.

Looking at national-level data, researchers found nearly every one of the 26 states with the highest COVID death rates had a higher-than-average proportion of Black or Hispanic residents, as well as a higher number of voters that for President Trump in 2020, researcher Tom Bollyky noted in comments released before the study’s publication.

Also associated with higher rates of COVID infection and death were lower rates of education, lower rates of trust among residents, and less access to quality health care, according to the researchers — an indicator of the interplay of racial inequities, health disparities and partisan politics that increased the burden of disease on disadvantaged groups, researchers said.