LOS ANGELES — The United States has the dubious distinction of suffering the highest COVID-19 mortality rate among the world's high-income countries. But that national average — 372 deaths per 100,000 people as of last summer — hides the fact that pandemic outcomes differed greatly from state to state.

In a comparison that controlled for demographic differences between states, Arizona's COVID-19 mortality rate of 581 deaths per 100,000 residents was almost four times higher than Hawaii's, where there were 147 deaths per 100,000 residents. Death rates in the hardest-hit U.S. states resembled those of countries with no healthcare infrastructure whatever. States that fared best had rates on a par with countries such as Australia, New Zealand and South Korea, which worked zealously to keep their pandemic death tolls low.

What accounts for these wide disparities? A new study offers some intriguing answers.

Race, ethnicity and socioeconomic factors were the most powerful predictors of a state's COVID-19 death toll, researchers found. The larger the proportion of residents who identified as Black or Latino, the higher the poverty rate, the greater the share of residents without health insurance and the lower the education level among adults, the more deaths there were per capita.

That may not be much of a surprise. But the researchers also discovered that the more people in a state trusted one another, the lower their collective risk of dying of COVID-19. That result underscores how America's growing divisiveness seems to have made us uniquely vulnerable during the pandemic.

"How we feel about one another matters," said political scientist Thomas J. Bollyke, one of the study's lead authors. "The solidarity between people — the feeling that others will also do the right thing, that you're not being taking advantage of — is a big driver in your willingness to adopt protective behaviors."

The report, published last week in the medical journal Lancet, is based on troves of U.S. pandemic data from January 2020 to July 2022. Bollyke called the undertaking "the most comprehensive statement to date on the drivers of outcomes in the pandemic."

Scores of researchers from across the country extracted data on states' demographic characteristics prior to the pandemic, looking for ways in which their behaviors and policies diverged as the pandemic proceeded. To make direct comparisons between states, they created standardized measures of infection and death rates that accounted for differences in COVID-relevant factors such as the ages and underlying health conditions of residents.

For instance, California's unadjusted rate of 291 COVID-19 deaths per 100,000 residents was lower than all but 11 states. But once research factored in that the state has a relatively young population with a low prevalence of conditions that make people vulnerable to severe cases of COVID-19, the mortality rate rose to 418 deaths per 100,000 residents. Only 15 states fared worse, the study authors found.

Demographics told only part of the story. Policy decisions mattered too.

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