Good point. In areas with lower cultvax uptake there is likely some skepticism of the medical industry that has mushroomed into something between total distrust and animosity. Some states like TN don't offer Medicaid outside of certain conditions. So general access to care, access to "free" care, the % of uninsured, and a culture of self-reliance plus understandable distrust is likely to produce a lot of downward pressure on medical visits.

Of course, with that you would think there would be an uptick in total mortality for untreated or late-treated illness resulting in higher general mortality, albeit with a difficult to discern time lag. Then again, as you fear, the medical industry - even before covid, was a leading killer behind only cancer and heart disease or somesuch. Seems they are giving the big deaths a run for #1.