Stokes AC, Lundberg DJ, Elo IT, et al. - While significant racial and socioeconomic inequities in directly assigned COVID-19 deaths have been recorded in prior studies, documentation of how excess mortality in 2020 has differed across sociodemographic or health factors in the United States is lacking. Researchers sought to determine the percentage of excess deaths assigned to COVID-19 and investigated variation in excess deaths by county characteristics by assessining data from 2,096 counties on COVID-19 and all-cause mortality. In these counties, they identified the occurrence of additional 20 deaths that were not counted as direct COVID-19 deaths, for every 100 deaths directly assigned to COVID-19 in official statistics. Counties with lower average socioeconomic status, counties with more comorbidities, and counties in the South and West were noted to have an even higher proportion of excess deaths not counted as direct COVID-19 deaths. In addition, the proportion of excess deaths not assigned to COVID-19 was higher in counties with more non-Hispanic Black residents, who were already at high risk of COVID-19 death based on direct counts. Overall, in 2020, excess mortality is significantly underestimated in direct COVID-19 death counts.