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. 2021 Dec;174(12):1693-1699.
doi: 10.7326/M21-2134. Epub 2021 Oct 5.

Racial and Ethnic Disparities in Excess Deaths During the COVID-19 Pandemic, March to December 2020

Meredith S Shiels  1 , Anika T Haque  1 , Emily A Haozous  2 , Paul S Albert  1 , Jonas S Almeida  1 , Montserrat García-Closas  1 , Anna M Nápoles  3 , Eliseo J Pérez-Stable  3 , Neal D Freedman  1 , Amy Berrington de González  1
Affiliations

Racial and Ethnic Disparities in Excess Deaths During the COVID-19 Pandemic, March to December 2020

Meredith S Shiels et al. Ann Intern Med. 2021 Dec.

Abstract

Background: Although racial/ethnic disparities in U.S. COVID-19 death rates are striking, focusing on COVID-19 deaths alone may underestimate the true effect of the pandemic on disparities. Excess death estimates capture deaths both directly and indirectly caused by COVID-19.

Objective: To estimate U.S. excess deaths by racial/ethnic group.

Design: Surveillance study.

Setting: United States.

Participants: All decedents.

Measurements: Excess deaths and excess deaths per 100 000 persons from March to December 2020 were estimated by race/ethnicity, sex, age group, and cause of death, using provisional death certificate data from the Centers for Disease Control and Prevention (CDC) and U.S. Census Bureau population estimates.

Results: An estimated 2.88 million deaths occurred between March and December 2020. Compared with the number of expected deaths based on 2019 data, 477 200 excess deaths occurred during this period, with 74% attributed to COVID-19. Age-standardized excess deaths per 100 000 persons among Black, American Indian/Alaska Native (AI/AN), and Latino males and females were more than double those in White and Asian males and females. Non-COVID-19 excess deaths also disproportionately affected Black, AI/AN, and Latino persons. Compared with White males and females, non-COVID-19 excess deaths per 100 000 persons were 2 to 4 times higher in Black, AI/AN, and Latino males and females, including deaths due to diabetes, heart disease, cerebrovascular disease, and Alzheimer disease. Excess deaths in 2020 resulted in substantial widening of racial/ethnic disparities in all-cause mortality from 2019 to 2020.

Limitations: Completeness and availability of provisional CDC data; no estimates of precision around results.

Conclusion: There were profound racial/ethnic disparities in excess deaths in the United States in 2020 during the COVID-19 pandemic, resulting in rapid increases in racial/ethnic disparities in all-cause mortality between 2019 and 2020.

Primary funding source: National Institutes of Health Intramural Research Program.

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Conflict of interest statement

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-2134.

Figures

Visual Abstract.
Visual Abstract.. Racial and Ethnic Disparities in Excess Deaths During the COVID-19 Pandemic.
Although racial and ethnic disparities in U.S. COVID-19 death rates are striking, focusing on COVID-19 deaths alone may underestimate the true effect of the pandemic on disparities. This study estimated excess deaths related and unrelated to COVID-19 in the United States from March to December 2020 by race/ethnicity, sex, age group, and cause.
Figure 1.
Figure 1.. Age-standardized all-cause deaths per 100 000 persons in the United States in March to December of 2019 and 2020 among males (A) and females (B) and age-standardized COVID-19 and non–COVID-19 excess deaths per 100 000 persons among males (C) and females (D), by race/ethnicity.
The total numbers of deaths (A and B) and excess deaths (C and D) are listed above the bars. Death rates for AI/AN persons are known to be underestimated due to racial misclassification on death certificates. AI/AN = American Indian/Alaska Native.
Figure 2.
Figure 2.. Age-specific all-cause deaths per 100 000 persons in the United States in March to December 2020 among males (A) and females (B) and age-specific COVID-19 (solid bars) and non–COVID-19 (striped bars) excess deaths per 100 000 persons among males (C) and females (D), by race/ethnicity.
AI/AN = American Indian/Alaska Native.
Appendix Figure 1.
Appendix Figure 1.. Comparison of excess deaths per 100 000 persons, by race/ethnicity.
Estimates used expected deaths based on 2018/2019 data (light green) and 2019 data (dark green). AI/AN = American Indian/Alaska Native.
Figure 3.
Figure 3.. Age-standardized non–COVID-19 cause-specific deaths per 100 000 persons in the United States in March to December 2020 among males (A) and females (B) and age-standardized non–COVID-19 excess cause-specific deaths per 100 000 persons among males (C) and females (D), by race/ethnicity.
AI/AN = American Indian/Alaska Native.
Appendix Figure 2.
Appendix Figure 2.. Total number of excess deaths among males, by month and race/ethnicity.
The dark green portion of each bar indicates deaths due to COVID-19, and the light green portion of each bar indicates non–COVID-19 causes. Population sizes are for June 2020. Note that the scale differs across plots.
Appendix Figure 3.
Appendix Figure 3.. Total number of excess deaths among females, by month and race/ethnicity.
The dark green portion of each bar indicates deaths due to COVID-19, and the light green portion of each bar indicates non–COVID-19 causes. Population sizes are for June 2020. Note that the scale differs across plots.
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References

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