Racial Disparities In Excess All-Cause Mortality During The Early COVID-19 Pandemic Varied Substantially Across States

Abstract

The impact of the coronavirus disease 2019 (COVID-19) pandemic has been starkly unequal across race and ethnicity. We examined the geographic variation in excess all-cause mortality by race and ethnicity to better understand the impact of the pandemic. We used individual-level administrative data on the US population between January 2011 and April 2020 to estimate the geographic variation in excess all-cause mortality by race and Hispanic origin. All-cause mortality allows a better understanding of the overall impact of the pandemic than mortality attributable to COVID-19 directly. Nationwide, adjusted excess all-cause mortality during that period was 6.8 per 10,000 for Black people, 4.3 for Hispanic people, 2.7 for Asian people, and 1.5 for White people. Nationwide averages mask substantial geographic variation. For example, despite similar excess White mortality, Michigan and Louisiana had markedly different excess Black mortality, as did Pennsylvania compared with Rhode Island. Wisconsin experienced no significant White excess mortality but had significant Black excess mortality. Further work understanding the causes of geographic variation in racial and ethnic disparities-the relevant roles of social and environmental factors relative to comorbidities and of the direct and indirect health effects of the pandemic-is crucial for effective policy making.

Exhibit 2:

Observed and predicted April mortality by race, 2011–2020 Source/Notes: SOURCE Authors’ calculations from Census Numident 2011–2020, 2010 Decennial Census, 2010 Census Modeled Race File, and 2010–19 Master Address File Auxiliary Reference File. NOTES Figures show observed and predicted all-cause mortality separately by race in the month of April, 2011–20. The race-specific trends are estimated as discussed in the statistical analysis on the full data set of 26,680,000,000 individual-months from January 2011 through April 2020. All results were approved for release by the US Census Bureau, authorization number CBDRB-FY21-ERD002-003.

Exhibit 4:

Association of Black non-Hispanic and White non-Hispanic excess all-cause mortality across states, April 2020 Source/Notes: Source/Notes: SOURCE Authors’ calculations from Census Numident 2011–2020, 2010 Decennial Census, 2010 Census Modeled Race File, and 2010–19 Master Address File Auxiliary Reference File. NOTES Figure reports the association in the estimates of sex- and age-adjusted all-cause excess mortality in April 2020 by state among non-Hispanic Black people versus non-Hispanic White people. The details of the regression analysis used to construct the estimates are reported in the statistical analysis. The trend line marks the line of best fit for the relationship between White and Black excess mortality by state. All results were approved for release by the US Census Bureau, authorization number CBDRB-FY21-ERD002-003.

Exhibit 5:

Association of Hispanic and White non-Hispanic excess all-cause mortality across states, April 2020 Source/Notes: Source/Notes: SOURCE Authors’ calculations from Census Numident 2011–2020, 2010 Decennial Census, 2010 Census Modeled Race File, and 2010–19 Master Address File Auxiliary Reference File. NOTES Figure reports the association in the estimates of sex- and age-adjusted all-cause excess mortality in April 2020 by state among Hispanic versus non-Hispanic White people. The details of the regression analysis used to construct the estimates are reported in the statistical analysis. The trend line marks the line of best fit for the relationship between White and Hispanic excess mortality by state. All results were approved for release by the US Census Bureau, authorization number CBDRB-FY21-ERD002-003.