Racial minorities see largest uptick in excess deaths amid pandemic

Three new studies add to growing evidence of the disproportionate effects of COVID-19 on racial and ethnic minorities in the United States, one of them finding that two of three excess deaths occurring so far in the pandemic were due to the novel coronavirus—with the largest increases seen in Hispanics and the 25-to-44-year age bracket.

In addition, one study of excess mortality found that US officials might be missing almost half of the deaths caused by COVID-19, or about 200,000 deaths so far this year.

Trends and demographic patterns

Led by researchers from the Centers for Disease Control and Prevention (CDC), the first study, published yesterday in Morbidity and Mortality Weekly Report, involved mining death data from the CDC's National Vital Statistics System. They found that 198,081 (66%) of the 299,028 excess deaths (increase from number of deaths during the same period in previous years) from Jan 26 to Oct 3 were attributable to COVID-19.

As of Oct 15, a total of 216,025 coronavirus deaths had been recorded in the United States, but this number may be lower than the actual number attributed to this cause because of limited availability and use of diagnostic and postmortem testing and inaccurate or incomplete cause-of-death data on death certificates, the authors noted.

In fact, they found that 198,081 excess deaths through Oct 3 are attributed to COVID-19—out of 299,028 excess deaths total—which almost doubles the official US tally.

The most all-cause excess deaths occurred during the weeks ending Apr 11 (40.4% excess) and Aug 8 (23.5%). While total excess deaths were lowest in people younger than 25 years and highest in those aged 75 to 84, the largest percentage change in deaths was, on average, in those 25 to 44. Numbers of deaths were 2.0% below average for those 25 and younger, +14.4% in those 45 to 64, +24.1% in those 65 to 74, +21.5% in those 75 to 84, and +14.7% in the 85-and-older age-group.

Native Americans/Alaska Natives had the lowest numbers of excess deaths (3,412), while whites had the highest (171,491). But the largest increase was in Hispanics (53.6%). While deaths were 11.9% higher than in previous years for whites, they were 28.9% above average in Native Americans, 32.9% higher for blacks, 36.6% higher for Asians, and 34.6% higher in those of unknown or other race or ethnicity.

"This report demonstrates important trends and demographic patterns in excess deaths that occurred during the COVID-19 pandemic," the authors wrote. "These results provide more information about deaths during the COVID-19 pandemic and inform public health messaging and mitigation efforts focused on the prevention of infection and mortality directly or indirectly associated with the COVID-19 pandemic and the elimination of health inequities."

Years of life lost

The second study, by Harvard University researchers, involved analyzing US Census and recently issued COVID-19 death data from the National Center for Health Statistics by race and ethnicity and age from Feb 1 to Jul 22.

The results, published yesterday in PLOS Medicine, show that by Jul 22, 68,377 whites, 29,476 blacks, 23,256 Hispanics, 6,468 Asians/Pacific Islanders, and 1,143 Native Americans/Alaska Natives had died of COVID-19. For reference, the US populations includes 186.4 million whites, 40.6 million blacks, 57.7 million Hispanics, 2.6 million Asians/Pacific Islanders, and 19.5 Native Americans/Alaska Natives.

More years of life were lost before age 65 in black and Hispanic populations than in their white counterparts in the United States—despite their smaller representation of the population. Blacks, Hispanics, and Native Americans/Alaska Natives faced a much larger risk of death from COVID-19 than whites from young adulthood to middle age.

Although older people made up of the largest proportion of deaths in all racial and ethnic groups, 10% of whites died before 65 years, in contrast with 28% of blacks, 37% of Hispanics, 45% of Native Americans/Alaska Natives, and 23% of Asians/Pacific Islanders.

The researchers said that their findings show that racial and ethnic minorities die of coronavirus at younger ages and at higher rates than whites.

"We observed racial variation in age-specific mortality rates not fully captured with examination of age-standardized rates alone," the authors said. "These findings suggest the importance of examining age-specific mortality rates and underscores how age standardization can obscure extreme variations within age strata. To avoid overlooking such variation, data that permit age-specific analyses should be routinely publicly available."

They also point out the very high COVID-19 death rates for black and Hispanic working-age adults, which they say cannot be explained only by higher proportions of underlying illnesses but could be due to inadequate workplace protections against the virus among low-wage essential workers.  

"While higher rates of chronic disease and barriers to healthcare access can be addressed by policy interventions, approaches that lower viral exposure would have an immediate short-term impact," the researchers said.

"Possible actions include permitting workers to stay home when personal or household members' health creates a higher risk for poor outcome, offering hazard pay, paid sick leave, health insurance, personal protective equipment, access to handwashing, and social distancing at work, along with, for those who so choose, alternative accommodation."

Risk of hospitalization, ICU admission, death

A related single-center, retrospective study published today in JAMA Network Open, found that black COVID-19 patients were 1.72 times more likely to be hospitalized than their white peers, although no significant differences were found in rates of intensive care unit (ICU) admission or death.

The University of Michigan researchers also showed a link between high population density, type 2 diabetes, and kidney disease and hospitalization in the 5,698 patients included in the study from Mar 10 to Apr 22.

Of the 1,139 patients diagnosed as having COVID-19, 492 (43.2%) were white, 442 (38.8%) were black, 523 (45.9%) were hospitalized, 283 (24.7%) were admitted to the ICU, and 88 (7.7%) died.

Obesity was a bigger risk factor for COVID-19 infection in black patients than in whites (odds ratio [OR] for blacks, 3.11; OR for whites, 1.37), as was cancer (OR for blacks, 1.82; OR for whites, 1.08). Having more underlying medical conditions was tied to a higher likelihood of hospitalization for white patients (OR, 1.30) but not black patients (OR, 0.99), similar to type 2 diabetes (OR for whites, 2.59; OR for blacks, 1.17).

The authors concluded that "These findings suggest that racial disparities existed in COVID-19 outcomes that cannot be explained after controlling for age, sex, socioeconomic status, and comorbidity score; therefore, targeted interventions to support high-risk populations are needed."

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