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Authors
Cosby, Arthur G.
Lebakula, Viswadeep https://orcid.org/0000-0001-5293-5914
Bergene, Karissa
Rico Mendez, Gina https://orcid.org/0000-0002-8021-6981
Bumgarner, Mackenzie
Peluso, Alina https://orcid.org/0000-0003-2895-0406
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Article History
Received: 13 December 2023
Revised: 24 November 2025
Accepted: 25 January 2026
First Online: 30 March 2026
Competing interests
: The authors declare no competing interests.
: We downloaded the county-level mortality data from Centres for Disease Control and Prevention (CDC) website ( ) and conducted the research by following the data restrictions specified in the Public Health Service Act (42 U.S.C. 242 m(d)). Additional county-level data is obtained from the U.S. Census. We confirm that all methods were performed in accordance with the relevant guidelines and regulations. The data utilised in this research was obtained from government sources that is publicly available at a coarser spatial resolution which is county level. So, this data does not have any type of personally identifiable information (PII). Hence approval from institutional review board is not required.
: This research used secondary data from the National Center for Health Statistics, the U.S. Census, and the Economic Research Service, USDA. No institutional review board approval was required.
