Death rates from COVID-19 varied dramatically across the United States, a major new analysis finds.
The report, published Thursday in medical journal The Lancet, looked at the rate of deaths throughout the country between January 2020 and July 2022.
COVID death rates in states like Arizona and New Mexico were roughly four times higher than in states like Hawaii, New Hampshire and Maine, researchers found.
The highest COVID-19 death rates were seen in Arizona with 581 deaths per 100,000 and Washington D.C. with 526 deaths per 100,000.
By comparison, the lowest rates of death were seen in Hawaii with 147 deaths per 100,000, New Hampshire with 215 deaths per 100,000 and Maine with 218 deaths per 100,000.
The authors of the study noted that Arizona's high death rate from COVID-19 deaths may be due to "inequality, some poverty...ultimately [low] vaccination rates and behaviors didn't line up to have good outcomes."
States that did well, like Hawaii, New Hampshire and Washington state, are states -- in most cases -- "[that] have done a good job restricting travel, and in some cases have less poverty, less inequality, and relatively high vaccination rates."
Additionally, states with larger proportions of people who identified as Black or Hispanic witnessed higher death rates.
Lower rates of infection and death from COVID-19 were seen in states with higher education levels, lower poverty levels and higher rates of self-reported trust in the federal government and in the scientific community.
"Nearly every state, from the 26 worst performing states in the pandemic, fall into one of the three...[either] disproportionately high population of people identifying as Hispanic...higher than the national average identifying as black...or high levels of support for the 2020 republican presidential candidate," said lead author Tom Bollyky, a senior fellow for global health, economics, and development at the Council on Foreign Relations and professor of law at Georgetown University, in a video commentary.
The authors further discussed parts of the study highlighting racial, economic and social inequities in the U.S. that led to differences in rates of infection and death rates between states.
States with higher poverty rates of poverty had higher death rates. For every 2.6% increase in poverty rates above the national average within a state, there was a 23.3% increase in the cumulative death rate, reflecting a significant economic healthcare disparity.
"The COVID-19 pandemic clearly exacerbated fundamental social and economic inequities, but science-based interventions and policy changes provided clear impact on mortality rates at the state level," said Dr. John Brownstein, an epidemiologist and chief innovation officer at Boston Children's Hospital and an ABC News contributor.
Policies adopted by states during the pandemic, including mask mandates, social distancing and vaccine mandates, were associated with lower COVID-19 infection rates and higher vaccination rates were associated with lower death rates.
"We can invest in programs that protect the communities that we see disproportionately affected by the pandemic," said co-lead author Emma Castro, a researcher at the Institute of Health Metrics and Evaluation at the University of Washington, in the video commentary. "We can invest in programs such as paid family and sick leaves, expanded health insurance and expanded Medicaid."
She continued, "These sorts of programs will protect individuals in the lower income bracket, and hopefully help void some of the unnecessary loss that we experienced in the pandemic."
Alaa Diab, MD, an internal medicine resident at Greater Baltimore Medical Center and MPH candidate at Johns Hopkins Bloomberg School of Public Health, is a contributor to the ABC News Medical Unit.
Keerthana Kumar, MD, MPH, a preventive medicine resident at the University of Kentucky, is a contributor to the ABC News Medical Unit.