Two new studies published in JAMA Network Open assess causes of death in US youth and pregnant and recently pregnant women during the pandemic, with the former finding that COVID-19 was the eighth-leading cause of death among children, and the latter showing that non-White pregnant women were significantly more likely to die of any cause than their White peers.
COVID deaths highest among infants
University of Oxford researchers led the first study, using data from the US Centers for Disease Control and Prevention (CDC) to identify the leading causes of death in youth aged 0 to 19 years from August 2021 to July 2022. The team compared COVID-19 deaths from April 2020 to August 2022 with non-COVID deaths in 2019 to 2021.
A total of 821 US youth died from August 2021 to July 2022, for a crude death rate of 1.0 per 100,000 people. By age-group, death rates were highest among infants younger than 1 year (4.3 per 100,000), falling to 0.6 for those 1 to 4 years, 0.4 for those 5 to 9, 0.5 for those 10 to 14; and 1.8 for those 15 to 19.
COVID-19 made up 2% of all deaths in this age-group (death rate, 1.0 per 100,000 people), and COVID-19 deaths were highest during the Delta and Omicron variant waves. The leading cause of death, perinatal conditions, had a death rate of 12.7 per 100,000; COVID-19 ranked ahead of influenza and pneumonia, which together had a death toll of 0.6 per 100,000.
COVID-19 was the eighth-leading cause of death among all causes, fifth among disease-related deaths, and first in infectious or respiratory diseases compared with 2019. By age-group, COVID-19 was the seventh leading cause of death for both infants and 1- to 4-year-olds, sixth for those aged 5 to 9 and 10 to 14, and fifth for those 15 to 19.
COVID-19 made up 2% of all deaths in this age-group, and COVID-19 deaths were highest during the Delta and Omicron variant waves.
Compared with other age-groups, the risk of death from COVID-19 was much lower in youth. For example, from August 2021 to July 2022, the death rate among all ages of the US population was 109 per 100,000.
In a University of Oxford news release, lead author Seth Flaxman, PhD, said that more than 1,300 US children have died of COVID-19, most of them during the past 2 years. "Fortunately, we now have an array of effective tools to minimize risk, from building ventilation to air purifiers to safe vaccines," he said. "Working together, communities can significantly limit the extent of infection and severe disease."
Pregnancy study: COVID caused 23 deaths, contributed to 171
University of Texas at San Antonio researchers led a study using National Center for Health Statistics data on causes of death among pregnant women and those who were recently pregnant (within 1 year) in 2019 and 2020.
Of 4,535 total deaths, 64% were women aged 34 years or younger. By race, 2.4% of the women were American Indian or Alaska Native, 2.8% were Asian or Pacific Islander, 14.8% were Hispanic, 28.1% were Black, 50.5% were White, and 1.4% were multiracial.
In 2020, the all-cause death rate for recently pregnant women rose 29%, from 53.9 to 69.6 per 100,000 live births (mortality rate ratio [MRR], 1.29). Rates of death from pregnancy-related causes climbed 22%, from 27.5 to 33.6 per 100,000 live births (MRR, 1.22), and deaths from non-pregnancy causes increased 36%, from 26.4 to 36.0 per 100,000 live births.
Death rates climbed significantly for drug poisoning (MRR, 1.42), motor vehicle accidents (MRR, 1.31), and homicide (MRR, 1.33). Suicide death rates didn't increase. COVID-19 was listed as the cause of 23 deaths but contributed to 171 others.
In 2020, the all-cause death rate for recently pregnant women rose 29%, from 53.9 to 69.6 per 100,000 live births.
Relative to White women, American Indian or Alaska Native women had significantly higher death rates for every cause. Black women had significantly higher death rates for all causes except drug poisoning and suicide, while Hispanic women had lower death rates all-cause, nonpregnancy, drug poisoning, motor vehicle collision, and suicide. Asian or Pacific Islander women had lower death rates across all causes, and multiracial women were more likely to die by homicide.
"Compared with non-Hispanic White women, mortality rates were 3- to 5-fold higher among American Indian or Alaska Native women for every cause, including suicide," the researchers wrote. "Likewise, these findings suggest that non-Hispanic Black women experienced significantly higher mortality rates across causes, with the highest rates for homicide. Enhanced surveillance and intervention for these vulnerable groups may be warranted."