The number of Georgia counties recording more deaths than births jumped again in 2021, due largely to a rising death toll that owed primarily to a combination of Covid-19 fatalities and lethal drug overdoses, according to data published Friday by the Georgia Department of Public Health (DPH).
The total number of Georgia’s 159 counties reporting more deaths than births rose to 123, up from 118 in 2020. That continued a trend that started about a decade ago. Up until 2010, the number of counties reporting more deaths than births had never reached 20, but since then — with a couple of exceptions — that number has climbed steadily. Pre-Covid, it appeared to have peaked at just under 80 counties in 2018 and ’19, then jumped to 118 in 2020, the first Covid year.
Statewide, the difference in the number of births and deaths narrowed to 11,618, the smallest gap ever recorded by DPH, as the chart at right illustrates. The total number of births actually ticked up slightly, but that gain was more than wiped out by the much bigger increase in deaths.
That gain took place almost entirely in TIGC’s Metro Atlanta region and on the Georgia coast, as this table shows.
Net Births by TIGC Region: 2019-2021
This table shows the difference between births and deaths for all five Trouble in God’s Country regions for the past three years. That difference has shrunk across the state, and a combination of Covid-19 and drug overdoses produced more deaths than births in predominantly rural areas of Middle, North, and South Georgia starting in 2019. The net gain in births was cut in half from 2019 to 2020, then nearly in half again in 2021. (Data Source: Georgia Department of Public Health)
While the counties reporting more deaths than births were mostly sparsely-populated rural counties, more than a half-dozen significant regional counties suffered more net deaths. Floyd and Walker counties, neighbors in northwest Georgia, reported the largest numbers of net deaths, 374 and 303, respectively. Other important regional population centers reporting more deaths than births included Bibb County (280), Glynn (261), Laurens (211), Thomas (192), and Dougherty (99).
Covid-19 claimed 15,790 Georgia lives in 2021, 14 percent of the state’s total deaths and an increase of 67.2 percent over 2020’s Covid death toll of 9,406. Fatal drug overdoses totaled 2,390, a 25.3 percent increase over 2020 and a 72 percent increase over 2019.
The Georgia Department of Public Health earlier this week published mortality data for 2019 and TIGC can now report that, for the second year in a row, right at half the state’s 159 counties reported more deaths than births.
For 2018, as TIGC reported a year ago, 79 counties reported more deaths than births; for 2019, 78 counties reported more deaths than births and one county — Treutlen — broke even, with 77 births and 77 deaths.
Only a few of the 78 counties would not be considered rural, either by dint of a small population or remote location. Perhaps most notably, Fayette County, on the southern edge of Metro Atlanta, and Floyd County, a major population and economic center in northwest Georgia, both found themselves in negative territory for the second year in a row. Fayette County has long been recognized as a popular area for retirees and has an older-than-average population; the reasons for Floyd County’s slippage are less apparent.
Other mid-sized but remotely located counties whose birth-to-death ratio has gone negative in recent years include Baldwin County (Milledgeville) and Sumter County (Americus).
This trend of increasing numbers of counties reporting more deaths than births is one first noticed and reported on by Trouble in God’s Country several years ago. My initial focus had been on the economic, educational and civic death of Georgia’s rural areas, but I decided one day to explore whether some counties might literally be dying. DPH’s publicly available OASIS database includes county-level birth and death data going back to 1994 and makes this analysis pretty simple.
What I found, though, was stunning, and very much a part of the story of rural Georgia’s decline, as the column chart below shows. Beginning roughly with onset of the Great Recession, the number of counties reporting more deaths than births began to tick up a fairly steady pace. While the Great Recession is generally considered to be over, the number of counties reporting more deaths than births has continued to rise.
We won’t know until at least next year whether the fact that this year’s number barely changed from 2018 represents a brief plateau or perhaps the beginning of a reversal of this trend. It’s also worth noting that none of the data through 2019 reflects the impact of the Covid-19 pandemic, which of course began in early 2020. The virus took a particularly heavy toll on southwest Georgia in its earliest months and is now rampaging through east-central and southeast Georgia.
Overall, Georgia continues to produce more births than deaths, but the statewide ratio has been tightening steadily for the past decade. For the first 15 of the 25 years for which DPH has county-level birth and death data, the statewide birth-to-death ratio floated along at about 2:1. It peaked in 2007 with 2.23 births for every death and has been narrowing ever since. For 2019, Georgia posted 1.47 births for every death, down from 1.48 in 2018.
Obviously, these two trends — the tightening of the state’s overall birth-to-death ratio and the increase in the number of counties with more deaths than births — are mirror images pulled from the same bucket of data. One story in the 2019 data, as noted above, is that the state may have hit, at least temporarily, a plateau of sorts. While the number of counties in negative territory dropped by one, the state’s overall birth-to-death ratio tightened ever so slightly, by one one-hundredth of a point. In other words, stasis in both analyses.
But another story to be pulled from this data is in the regional differences. As the tables below shows, it puts yet another spotlight on the profound population shift away from rural Georgia and toward Metro Atlanta (defined by TIGC as a 12-county region).
One takeaway from the regional analysis emerges from a comparison of the 99 counties that make up Middle and South Georgia with the 12-county Metro Atlanta region. While Middle and South Georgia combined produced only 60 percent as many births as Metro Atlanta, they very nearly matched Metro Atlanta is deaths: 30,488 for Middle and South Georgia versus 30,589 for Metro Atlanta.
In closing, as a teaser of sorts, I’ll point out that there are obviously racial and political dimensions to this data. While 78 counties recorded more overall deaths than births, 103 counties reported more White deaths than White births; only 48 counties reported more Black deaths than Black births.
Statewide, the White birth-to-death ratio peaked at 1.92:1 in 2006 and has fallen steadily since then — to 1.18:1 in 2019. The Black birth-to-death ratio hit its high point a year later, in 2007, at 2.77:1 and has since fallen to 1.87:1 in 2019. I’ll try to flesh out the political implications of these trends in a future post.
Have a question or suggestion for TIGC? Email Charlie Hayslett at firstname.lastname@example.org