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. 2021 Mar 12;18(6):2921.
doi: 10.3390/ijerph18062921.

Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

Jay J Xu  1 , Jarvis T Chen  2 , Thomas R Belin  1   3 , Ronald S Brookmeyer  1 , Marc A Suchard  1   4   5 , Christina M Ramirez  1
Affiliations

Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

Jay J Xu et al. Int J Environ Res Public Health. .

Abstract

The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios-anchoring comparisons to non-Hispanic Whites-in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.

Keywords: COVID-19; Monte Carlo simulation; SARS-CoV-2; communities of color; coronavirus; medical mistrust; public health; racial and ethnic disparities; social determinants of health; years of potential life lost.

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Conflict of interest statement

T.R.B. has received support from NIH/NCATS grant UL1 TR001881 and NIH/NIMH grant P30 MH058107 in addition to funding outside the scope of this work from the Patient Centered Outcomes Research Institute and the Movember Foundation. M.A.S. has received contracts from Janssen Research & Development, LLC; Private Health Management, Inc.; the United States Department of Veteran Affairs; and the United States Food & Drug Administration and research grants from the National Institutes of Health, all outside the scope of this work. C.M.R. has received a contract from Private Health Management, Inc. outside the scope of this work.

Figures

Figure 1
Figure 1
Conservative 95% interval estimates of the percentage of total COVID-19-attributable YPLL before age 75, intervals denoting the entire plausible range for the percentage of total COVID-19 deaths, and the percent population shares for NH Whites in the U.S. and in each examined state with respect to cumulative COVID-19 deaths according to data from the National Center for Health Statistics as of 30 December 2020.
Figure 2
Figure 2
Conservative 95% interval estimates of the percentage of total COVID-19-attributable YPLL before age 75, intervals denoting the entire plausible range for the percentage of total COVID-19 deaths, and the percent population shares for NH Blacks in the U.S. and in each examined state with respect to cumulative COVID-19 deaths according to data from the National Center for Health Statistics as of 30 December 2020.
Figure 3
Figure 3
Conservative 95% interval estimates of the age-adjusted NH Black-to-NH White YPLL and mortality RR’s in the U.S. and in each examined state with respect to cumulative COVID-19 deaths according to data from the National Center for Health Statistics as of 30 December 2020. States are ordered from top to bottom in descending order of the signed difference between the lower limit of the YPLL RR interval and the upper limit of the mortality RR interval. Values are displayed on the base 10 logarithmic scale. Interval endpoints above 20.0 and below 0.30 are truncated, with the actual values numerically annotated.
Figure 4
Figure 4
Conservative 95% interval estimates of the percentage of total COVID-19-attributable YPLL before age 75, intervals denoting the entire plausible range for the percentage of total COVID-19 deaths, and the percent population shares for Hispanics in the U.S. and in each examined state with respect to cumulative COVID-19 deaths according to data from the National Center for Health Statistics as of 30 December 2020.
Figure 5
Figure 5
Conservative 95% interval estimates of the age-adjusted Hispanic-to-NH White YPLL and mortality RR’s in the U.S. and in each examined state with respect to cumulative COVID-19 deaths according to data from the National Center for Health Statistics as of 30 December 2020. States are ordered from top to bottom in descending order of the signed difference between the lower limit of the YPLL RR interval and the upper limit of the mortality RR interval. Values are displayed on the base 10 logarithmic scale. Interval endpoints above 20.0 and below 0.30 are truncated, with the actual values numerically annotated.
Figure 6
Figure 6
Conservative 95% interval estimates of the percentage of total COVID-19-attributable YPLL before age 75, intervals denoting the entire plausible range for the percentage of total COVID-19 deaths, and the percent population shares for NH Asians in the U.S. and in each examined state with respect to cumulative COVID-19 deaths according to data from the National Center for Health Statistics as of 30 December 2020.
Figure 7
Figure 7
Conservative 95% interval estimates of the age-adjusted NH Asian-to-NH White YPLL and mortality RR’s in the U.S. and in each examined state with respect to cumulative COVID-19 deaths according to data from the National Center for Health Statistics as of 30 December 2020. States are ordered from top to bottom in descending order of the signed difference between the lower limit of the YPLL RR interval and the upper limit of the mortality RR interval. Values are displayed on the base 10 logarithmic scale. Interval endpoints above 20.0 and below 0.30 are truncated, with the actual values numerically annotated.
Figure 8
Figure 8
Conservative 95% interval estimates of the percentage of total COVID-19-attributable YPLL before age 75, intervals denoting the entire plausible range for the percentage of total COVID-19 deaths, and the percent population shares for NH AIAN’s in the U.S. and in each examined state with respect to cumulative COVID-19 deaths according to data from the National Center for Health Statistics as of 30 December 2020.
Figure 9
Figure 9
Conservative 95% interval estimates of the age-adjusted NH AIAN-to-NH White YPLL and mortality RR’s in the U.S. and in each examined state with respect to cumulative COVID-19 deaths according to data from the National Center for Health Statistics as of 30 December 2020. States are ordered from top to bottom in descending order of the signed difference between the lower limit of the YPLL RR interval and the upper limit of the mortality RR interval. Values are displayed on the base 10 logarithmic scale. Interval endpoints above 20.0 and below 0.30 are truncated, with the actual values numerically annotated.
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