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. 2024 Oct 1;7(10):e2438918.
doi: 10.1001/jamanetworkopen.2024.38918.

Racial and Ethnic Disparities in Age-Specific All-Cause Mortality During the COVID-19 Pandemic

Jeremy Samuel Faust  1   2 , Benjamin Renton  3   4 , Tasce Bongiovanni  5 , Alexander Junxiang Chen  5 , Karen Dorsey Sheares  6   7 , Chengan Du  8 , Utibe R Essien  9 , Elena Fuentes-Afflick  5 , Trent Haywood  10 , Rohan Khera  7   11 , Terris King  12 , Shu-Xia Li  8 , Zhenqiu Lin  8 , Yuan Lu  7   11 , Andrew D A Marshall  1 , Chima D Ndumele  13 , Ijeoma Opara  14 , Tina Loarte-Rodriguez  8 , Mitsuaki Sawano  8 , Kekoa Taparra  15 , Herman A Taylor  16 , Karol E Watson  17 , Clyde W Yancy  10 , Harlan M Krumholz  8
Affiliations

Racial and Ethnic Disparities in Age-Specific All-Cause Mortality During the COVID-19 Pandemic

Jeremy Samuel Faust et al. JAMA Netw Open. .

Abstract

Importance: The end of the COVID-19 public health emergency (PHE) provides an opportunity to fully describe pandemic-associated racial and ethnic mortality disparities. Age-specific excess mortality differences have important downstream implications, especially in minoritized race and ethnicity populations.

Objectives: To characterize overall and age-specific all-cause excess mortality by race and ethnicity during the COVID-19 PHE and assess whether measured differences reflected changes from prepandemic disparities.

Design, setting, and participants: This cross-sectional study analyzed data of all US residents and decedents during the COVID-19 PHE, aggregated by observed race and ethnicity (at time of death) and age. Statistical analysis was performed from March 2020 to May 2023.

Exposures: COVID-19 PHE period (March 2020 to May 2023).

Main outcomes and measures: All-cause excess mortality (incident rates, observed-to-expected ratios) and all-cause mortality relative risks before and during the PHE.

Results: For the COVID-19 PHE period, data for 10 643 433 death certificates were available; mean (SD) decedent age was 72.7 (17.9) years; 944 318 (8.9%) were Hispanic; 78 973 (0.7%) were non-Hispanic American Indian or Alaska Native; 288 680 (2.7%) were non-Hispanic Asian, 1 374 228 (12.9%) were non-Hispanic Black or African American, 52 905 (0.5%) were non-Hispanic more than 1 race, 15 135 (0.1%) were non-Hispanic Native Hawaiian or Other Pacific Islander, and 7 877 996 (74.1%) were non-Hispanic White. More than 1.38 million all-cause excess deaths (observed-to-expected ratio, 1.15 [95% CI, 1.12-1.18]) occurred, corresponding to approximately 23 million years of potential life lost (YPLL) during the pandemic. For the total population (all ages), the racial and ethnic groups with the highest observed-to-expected all-cause mortality ratios were the American Indian or Alaska Native (1.34 [95% CI, 1.31-1.37]) and Hispanic (1.31 [95% CI, 1.27-1.34]) populations. However, higher ratios were observed in the US population aged 25 to 64 years (1.20 [95% CI, 1.18-1.22]), greatest among the American Indian or Alaska Native (1.45 [95% CI, 1.42-1.48]), Hispanic (1.40 [95% CI, 1.38-1.42]), and Native Hawaiian or Other Pacific Islander (1.39 [95% CI, 1.34-1.44]) groups. In the total population aged younger than 25 years, the Black population accounted for 51.1% of excess mortality, despite representing 13.8% of the population. Had the rate of excess mortality observed among the White population been observed among the total population, more than 252 000 (18.3%) fewer excess deaths and more than 5.2 million (22.3%) fewer YPLL would have occurred.

Conclusions and relevance: In this cross-sectional study of the US population during the COVID-19 PHE, excess mortality occurred in all racial and ethnic groups, with disparities affecting several minoritized populations. The greatest relative increases occurred in populations aged 25 to 64 years. Documented differences deviated from prepandemic disparities.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Khera reported being an academic cofounder of Evidence2Health and of Ensight-AI; receiving grants from Bristol Myers Squibb through Yale, grants from Novo Nordisk through Yale, and grants from BridgeBio through Yale outside the submitted work. Dr Lu reported grants from the National Institutes of Health, Patient-Centered Outcomes Research Institute, and the Sentara Research Foundation outside the submitted work. Dr Sawano reported grants from Pfizer and Polybio outside the submitted work. Dr Yancy reported spousal salary from Abbott Labs. Dr Krumholz reported receiving options for Element Science and Identifeye and payments from F-Prime for advisory roles; he is a cofounder of and holds equity in Hugo Health, Refactor Health, and ENSIGHT-AI; and he received through Yale University research contracts from Janssen, Kenvue, Novartis, and Pfizer. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Observed-to-Expected Ratios for All-Cause Mortality During the Pandemic Period by Race and Ethnicity
For each group, the graphed ratio reflects raw observed deaths divided by the number of modeled expected deaths during the pandemic period for that specific population; 95% CIs are shown as horizontal bars. The vertical line (1.0) means no change.
Figure 2.
Figure 2.. Monthly All-Cause Excess Mortality and COVID-19–Specific Mortality by Race and Ethnicity for All Ages
The vertical dashed lines show the start of the vaccine era (using March 2021). Blue lines show excess mortality; orange lines show COVID-19-specific mortality. The Spearman correlation coefficient relating the lines are shown for each race and ethnicity, with their corresponding P values. IR indicates incident rate.
Figure 3.
Figure 3.. Relative Risk (RR) of Age-Adjusted All-Cause Mortality Compared With Same-Age White Population
The dashed vertical lines denote the start of the COVID-19 pandemic period. A, Prepandemic and postpandemic mortality RRs for all ages. B, all ages, by year. C, all ages, by month. Monthly mortality RRs by ages 0-24 years (D), ages 25-64 years (E), and ages 65 years and older (F). American Indian and Alaska Native is shown in blue, Asian in green, Black in gray, Hispanic in red, Native Hawaiian and Other Pacific Islander in orange. 95% CIs are shown for each line compared with the White population. Some CIs may be imperceptible due to narrow bandwidths.
See this image and copyright information in PMC

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