Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 1;6(5):e2311098.
doi: 10.1001/jamanetworkopen.2023.11098.

COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022

Affiliations

COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022

Dielle J Lundberg et al. JAMA Netw Open. .

Abstract

Importance: Prior research has established that Hispanic and non-Hispanic Black residents in the US experienced substantially higher COVID-19 mortality rates in 2020 than non-Hispanic White residents owing to structural racism. In 2021, these disparities decreased.

Objective: To assess to what extent national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and subsequent Omicron wave reflect reductions in mortality vs other factors, such as the pandemic's changing geography.

Design, setting, and participants: This cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, among adults aged 25 years and older residing in the US. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between initial and Omicron waves was decomposed. Data were analyzed from June 2021 through March 2023.

Exposures: Metropolitan vs nonmetropolitan areas and race and ethnicity.

Main outcomes and measures: Age-standardized death rates.

Results: There were death certificates for 977 018 US adults aged 25 years and older (mean [SD] age, 73.6 [14.6] years; 435 943 female [44.6%]; 156 948 Hispanic [16.1%], 140 513 non-Hispanic Black [14.4%], and 629 578 non-Hispanic White [64.4%]) that included a mention of COVID-19. The proportion of COVID-19 deaths among adults residing in nonmetropolitan areas increased from 5944 of 110 526 deaths (5.4%) during the initial wave to a peak of 40 360 of 172 515 deaths (23.4%) during the Delta wave; the proportion was 45 183 of 210 554 deaths (21.5%) during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100 000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased from 339 to 45 deaths from the initial to Omicron wave, or by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 120 deaths/100 000 person-years of the decrease (40.7%); 58 deaths/100 000 person-years in the decrease (19.6%) were explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults reside. The remaining 116 deaths/100 000 person-years in the decrease (39.6%) were explained by decreases in death rates in non-Hispanic Black adults.

Conclusions and relevance: This study found that most of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic spread of the pandemic. These findings suggest that despite media reports of a decline in disparities, there is a continued need to prioritize racial health equity in the pandemic response.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Nsoesie reported receiving personal fees from Novartis outside the submitted work and participating in the Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity Program team at the National Institutes of Health through the Intergovernmental Personnel Act Mobility Program. Dr Stokes reported receiving grants from Johnson & Johnson and Swiss Re outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Monthly Adult Age-Standardized COVID-19 Death Rates
Death rates were standardized using 3 age groups (25-54, 55-74, and ≥75 years) and the overall US 2020 population as the standard population. Non-Hispanic American Indian and Alaska Native, non-Hispanic Asian, and non-Hispanic Native Hawaiian and other Pacific Islander adults were excluded from this figure due to substantial data suppression at this level of temporal detail. Death rates were annualized and reported in units of COVID-19 deaths per 100 000 person-years.
Figure 2.
Figure 2.. Decomposition of Mechanisms Contributing to National Changes in Racial and Ethnic Disparities
For each comparison of racial and ethnic groups and waves, components add up to the total change in disparities. The component consisting of changes in mortality outcomes associated with shifts in the racial and ethnic population composition of metropolitan and nonmetropolitan areas was omitted from the figure because it contributed between −0.2% and 0.1% to the change in disparities across wave and racial and ethnic group comparisons.

Update of

Similar articles

Cited by

References

    1. Millett GA, Jones AT, Benkeser D, et al. . Assessing differential impacts of COVID-19 on Black communities. Ann Epidemiol. 2020;47:37-44. doi:10.1016/j.annepidem.2020.05.003 - DOI - PMC - PubMed
    1. Chen JT, Krieger N. Revealing the Unequal Burden of COVID-19 by Income, Race/Ethnicity, and Household Crowding: US County Versus Zip Code Analyses. J Public Health Manag Pract. 2021;27(Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward):S43-S56. doi:10.1097/PHH.0000000000001263 - DOI - PubMed
    1. Mude W, Oguoma VM, Nyanhanda T, Mwanri L, Njue C. Racial disparities in COVID-19 pandemic cases, hospitalisations, and deaths: a systematic review and meta-analysis. J Glob Health. 2021;11:05015. doi:10.7189/jogh.11.05015 - DOI - PMC - PubMed
    1. Luck AN, Preston SH, Elo IT, Stokes AC. The unequal burden of the COVID-19 pandemic: capturing racial/ethnic disparities in US cause-specific mortality. SSM Popul Health. 2022;17:101012. doi:10.1016/j.ssmph.2021.101012 - DOI - PMC - PubMed
    1. Muñoz-Price LS, Nattinger AB, Rivera F, et al. . Racial disparities in incidence and outcomes among patients with COVID-19. JAMA Netw Open. 2020;3(9):e2021892. doi:10.1001/jamanetworkopen.2020.21892 - DOI - PMC - PubMed

Publication types

MeSH terms