COVID-19-Associated Orphanhood and Caregiver Death in the United States

Abstract

Background: Most coronavirus disease 2019 (COVID-19) deaths occur among adults, not children, and attention has focused on mitigating COVID-19 burden among adults. However, a tragic consequence of adult deaths is that high numbers of children might lose their parents and caregivers to COVID-19-associated deaths.

Methods: We quantified COVID-19-associated caregiver loss and orphanhood in the United States and for each state using fertility and excess and COVID-19 mortality data. We assessed burden and rates of COVID-19-associated orphanhood and deaths of custodial and coresiding grandparents, overall and by race and ethnicity. We further examined variations in COVID-19-associated orphanhood by race and ethnicity for each state.

Results: We found that from April 1, 2020, through June 30, 2021, >140 000 children in the United States experienced the death of a parent or grandparent caregiver. The risk of such loss was 1.1 to 4.5 times higher among children of racial and ethnic minority groups compared with non-Hispanic White children. The highest burden of COVID-19-associated death of parents and caregivers occurred in Southern border states for Hispanic children, in Southeastern states for Black children, and in states with tribal areas for American Indian and/or Alaska Native populations.

Conclusions: We found substantial disparities in distributions of COVID-19-associated death of parents and caregivers across racial and ethnic groups. Children losing caregivers to COVID-19 need care and safe, stable, and nurturing families with economic support, quality child care, and evidence-based parenting support programs. There is an urgent need to mount an evidence-based comprehensive response focused on those children at greatest risk in the states most affected.

FIGURE 1

Classification of deaths of parents, custodial grandparents, coresiding grandparents providing most basic needs, and coresiding grandparents providing some basic needs.

FIGURE 2

A, Total estimated children losing at least one primary caregiver (parent or custodial grandparent) to COVID-19: cumulative totals across states ordered by number of caregivers lost from bottom lowest (New Hampshire) to top highest (California). B, Estimated children losing at least one primary caregiver by race and ethnicity. PLUS indicates each state is added to the cumulative total shown on the x-axis.

FIGURE 3

Share of population, COVID-19–associated deaths, and children losing primary caregivers (parents or custodial grandparents) to COVID-19 by race and ethnicity. A, US total. B, By state.

FIGURE 4

A, COVID-19–associated deaths per state by race and ethnicity per 100 000 residents aged >15 years in each state. B, Estimated loss of primary caregiver per 100 000 children aged <18 in each state by race and ethnicity. Rates at the national level are on the left, and rates at the state level are on the right.

FIGURE 5

Findings by state and race and ethnicity. A, For reference, rate of COVID-19–associated deaths per 100 000 residents aged >15 years. B, Number of children losing a primary caregiver. C, Rate of loss of primary caregiver per 100 000 children aged 0 to 17 years. D, Rate of loss of primary caregiver per 1000 Hispanic or non-White children and per 1000 non-Hispanic White children (ordered by rate ratio of Hispanic or non-White and/or non-Hispanic children).