COVID-19 mortality in California based on death certificates: disproportionate impacts across racial/ethnic groups and nativity

Abstract

Purpose To examine characteristics of coronavirus disease 2019 (COVID-19) decedents in California (CA) and evaluate for disproportionate mortality across race/ethnicity and ethnicity/nativity. Methods COVID-19 deaths were identified from death certificates. Age-adjusted mortality rate ratios (MRR) were compared across race/ethnicity. Proportionate mortality rates (PMR) were compared across race/ethnicity and by ethnicity/nativity. Results We identified 10,200 COVID-19 deaths in CA occurring February 1 through July 31, 2020. The most frequently observed characteristics among decedents were age 65 years or above, male, Hispanic, foreign-born, and educational attainment of High School or below. MRR indicated elevated COVID-19 morality rates among Asian/Pacific Islander, Black, and Hispanic groups compared with the White group, with Black and Hispanic groups having the highest MRR at 2.75 (95%CI: 2.54–2.97) and 4.18 (95%CI: 3.99–4.37), respectively. Disparities were larger at younger ages. Similar results were observed with PMR, and patterns of age-racial/ethnic disparities remained in analyses stratified by education. Elevated PMR were observed in all ethnicity/nativity groups, especially foreign-born Hispanic individuals, relative to U.S.-born non-Hispanic individuals. These were generally larger at younger ages and persisted after stratifying by education. Conclusions Differential COVID-19 mortality was observed in California across racial/ethnic groups and by ethnicity/nativity groups with evidence of greater disparities among younger age groups. Identifying COVID-19 disparities is an initial step toward mitigating disease impacts in vulnerable communities.

Association between Preferred Language and Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children in the United States

“…Foreign-born individuals also had elevated proportionate mortality rates compared with individuals born in the United States, in an examination of death files in California. 11 Similar findings have been reported in other countries, including the United Kingdom and Canada. 12 , 13 Together with our results, these studies highlight the disproportionate burden of the SARS-CoV-2 pandemic for immigrant families and families who prefer a language other than English, and support continued calls for large-scale interventions to reverse systemic inequities for those families.…”

An integrated risk and epidemiological model to estimate risk-stratified COVID-19 outcomes for Los Angeles County: March 1, 2020—March 1, 2021

“…We focus our modeling framework on the risk factors age, comorbidities, obesity, and smoking status as these demographic and medical conditions have consistently been identified across various studies as factors inducing the probability of progressing to severe illness given COVID-19 infection [ 8 ]. We do not include race/ethnicity as a factor, because although strongly predictive of the risk of overall mortality from COVID-19 [ 17 ], it has been shown that increased exposure risk and not race per se explains racial disparities in COVID-19 health outcomes [ 38 , 39 ].…”

“…Extreme disparities in infection incidence and mortality have been observed for different communities within LAC. This includes incidence rates up to 15 times higher in low-income neighborhoods in East LA with high percentages of essential workers than in affluent communities in West LA [ 14 ], and COVID deaths as a proportion of the typical total deaths 11.6 times higher for young, foreign-born Latinx than for young, U.S.-born, non-Hispanics (for California) [ 17 ]. These large differences in infection incidence and death will undoubtedly translate into large differences in probabilities of disease progression and IFR .…”

“…We justify this assumption because the majority of confirmed COVID-19 deaths cases result from individuals who die in SNF, hospital, or following a stay in hospital; analysis of death certificate data from California indicates that 4%-9% of official COVID-19 deaths have occurred at home, across the three epidemic waves (E. Garcia, personal communication based on unpublished data for the state of California, April 20, 2021). Furthermore, we do not model a route to death for individuals without a confirmed COVID-19 infection ( A ), since record of confirmed COVID-19 infection (or probable based on clinical evidence) is needed to be classified as COVID-19 mortality [ 17 ].…”

Long-term air pollution and COVID-19 mortality rates in California: Findings from the Spring/Summer and Winter surges of COVID-19

“…Details of our COVID-19 mortality assessment method have been previously published ( Garcia et al, 2021 ). Briefly, we used an internally developed algorithm to identify COVID-19-related deaths using the new International Statistical Classification of Diseases and Related Health Problems code for COVID-19 (U07.1) and a keyword search of variables related to immediate and underlying causes of death or other significant conditions that contributed to death.…”