American Public Health Association (APHA)

April 2021 Issue of AJPH highlights COVID-19 as it relates to unemployment and excess deaths in Florida, Medicaid expansion, and misinformation spread by crowdfunding campaigns

To request a full copy of any of these studies or for information on scheduling interviews with an expert, contact APHA Media Relations.

American Journal of Public Health April issue highlights:

  • Thousands of excess deaths linked to COVID-19-related unemployment
  • Medicaid expansion tied to higher PrEP use among men who have sex with men
  • Excess deaths in Florida suggest higher-than-reported COVID-19 toll
  • Crowdfunding campaigns spreading COVID-19 misinformation

Thousands of excess deaths linked to COVID-19-related unemployment

The historic spikes in U.S. unemployment caused by the pandemic could lead to thousands of excess deaths, according to a new study in the April issue of AJPH.

Between April 2020 and March 2021, researchers estimated about 30,200 excess deaths attributable to COVID-19-related unemployment. Such deaths were disproportionately higher among men, Black people and those with lower educational attainment.

To conduct the study, researchers used previously published data on the association between unemployment and mortality, unemployment data from the U.S. Bureau of Labor Statistics, and mortality data from the Centers for Disease Control and Prevention to project attributable deaths among workers ages 25 to 64.

Among the findings, people with a high school education or less represented 72% of unemployment-related deaths, while only making up 37% of the general population. Black people, who make up 12% of the population, represented 19% of unemployment-related deaths.

“Adequate responses to pandemics would require adopting specific policies to protect workers and mitigate the harms of unemployment, while intervening in long-standing, unjust social structures,” study authors wrote. “Proactive public policies are needed to prevent further inequitable health and social consequences of the COVID-19 pandemic.”

[Author contact: Ellicott C. Matthay, University of California-San Francisco Center for Health and Community, San Francisco, California. “Projected All-Cause Deaths Attributable to COVID-19-Related Unemployment in the United States”]

Medicaid expansion tied to higher PrEP use among men who have sex with men

Men who have sex men and live in a Medicaid expansion state are more likely to use pre-exposure prophylaxis, or PrEP, which can prevent HIV infection, finds a new study in April’s AJPH.

Using data from the National HIV Behavioral Surveillance system, researchers compared usage among men who have sex with men in the 37 states that expanded Medicaid as of 2017 against those living in states where lawmakers rejected expansion. They found that those living in expansion states were more likely to discuss PrEP with a provider and more likely to use PrEP than their counterparts in nonexpansion states — at about 58.8% vs. 44.3% and 31.1% vs. 17.5%, respectively.

Men who have sex with men and live in expansion states were also more likely to have health insurance than their nonexpansion counterparts, at 87.9% vs. 71.6%.

“(Men who have sex with men) living in nonexpansion states reported lower health care coverage and utilization, including PrEP use,” the study stated. “Lower access and utilization of care could have implications for curbing new HIV infections and present a challenge for making the goal of ending the HIV epidemic a reality.”

[Author contact: Amy Baugher, Centers for Disease Control and Prevention, Atlanta, Georgia. “Health Care Coverage and Preexposure Prophylaxis (PrEP) Use Among Men Who Have Sex With Men Living in 22 U.S. Cities With Medicaid Expansion, 2017”]

Excess deaths in Florida suggest higher-than-reported COVID-19 toll

Recent total deaths in Florida are much higher than historical trends, even when accounting for COVID-19, suggesting the real impact of the coronavirus is likely higher than official data suggest, according to a new study in April’s AJPH.

Researchers estimated excess deaths during the pandemic by subtracting official data on COVID-19 deaths and forecasted monthly deaths from total, all-cause deaths between March and September 2020. They also used historic data and modeling to estimate the number of monthly deaths that would have taken place in Florida had the pandemic not happened.

Florida experienced about 19,200 excess deaths during the study period, researchers estimated. In the absence of the pandemic, total deaths would have been more than 26% and over 27% lower in July and August, respectively. Officially recorded COVID-19 mortality accounted for about 14,300 of the deaths, but about 5,000 excess deaths are unexplained, the study found.

“The mortality burden of COVID-19 is significantly higher than what the official tally suggests,” researchers wrote. “Examination of excess deaths during the pandemic requires greater attention to aid efforts to reduce the impact of COVID-19 on population health.”

[Author contact: Moosa Tatar, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah. “Analysis of Excess Deaths During the COVID-19 Pandemic in the State of Florida”]

Crowdfunding campaigns spreading COVID-19 misinformation

Crowdfunding campaigns are a source of misinformation about COVID-19 prevention and treatment, finds new research published in April’s AJPH.

Study authors searched the GoFundMe crowdfunding platform using 172 terms associated with medical misinformation about COVID-19 prophylaxes and treatments over a handful of days in June 2020. They identified more than 200 crowdfunding campaigns worldwide that were requesting over $21,000,000, raised about $324,300 from over 4,300 donors, and were shared more than 24,000 times.

The most discussed interventions were dietary supplements and purported immune system boosters, followed by other forms of complementary and alternative medicine such as essential oils, and unproven medical interventions such as hydroxychloroquine. More than 82% of the campaigns made definitive claims about efficacy.

“GoFundMe should join other online and social media platforms to actively restrict campaigns that spread misinformation about COVID-19 or seek to better inform campaigners about evidence-based prophylaxes and treatments,” study authors wrote.

[Author contact: Jeremy Snyder, Simon Fraser University, Burnaby, British Columbia, Canada. “Crowdfunding Campaigns and COVID-19 Misinformation”]

Check out the full list of AJPH research papers that published online in our First Look area.

These articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association and is available at

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