Excess Mortality in California During the Coronavirus Disease 2019 Pandemic, March to August 2020

Chen, Yea Hung; Glymour, M. Maria; Catalano, Ralph; Fernández, Alicia; Nguyen, Tung T.; Kushel, Margot; Bibbins‐Domingo, Kirsten

doi:10.1001/jamainternmed.2020.7578

Cited by 52 publications

(80 citation statements)

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“…8 , 9 , 10 , 11 , 12 , 13 , 14 In addition, Latinx individuals have had some of the highest rates of excess mortality compared with other racial and ethnic groups and have not been shown to benefit from shelter-in-place policies. 14 …”

Section: Introductionmentioning

confidence: 99%

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Experiences of Latinx Individuals Hospitalized for COVID-19

et al. 2021

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IMPORTANCE Latinx individuals, particularly immigrants, are at higher risk than non-Latinx White individuals of contracting and dying from coronavirus disease 2019 (COVID-19). Little is known about Latinx experiences with COVID-19 infection and treatment. OBJECTIVE To describe the experiences of Latinx individuals who were hospitalized with and survived COVID-19. DESIGN, SETTING, AND PARTICIPANTS The qualitative study used semistructured phone interviews of 60 Latinx adults who survived a COVID-19 hospitalization in public hospitals in San Francisco, California, and Denver, Colorado, from March 2020 to July 2020. Transcripts were analyzed using qualitative thematic analysis. Data analysis was conducted from May 2020 to September 2020. MAIN OUTCOMES AND MEASURES Themes and subthemes that reflected patient experiences. RESULTS Sixty people (24 women and 36 men; mean [SD] age, 48 [12] years) participated. All lived in low-income areas, 47 participants (78%) had more than 4 people in the home, and most (44 participants [73%]) were essential workers. Four participants (9%) could work from home, 12 (20%) had paid sick leave, and 21 (35%) lost their job because of COVID-19. We identified 5 themes (and subthemes) with public health and clinical care implications: COVID-19 was a distant and secondary threat (invincibility, misinformation and disbelief, ingrained social norms); COVID-19 was a compounder of disadvantage (fear of unemployment and eviction, lack of safeguards for undocumented immigrants, inability to protect self from COVID-19, and high-density housing); reluctance to seek medical care (worry about health care costs, concerned about ability to access care if uninsured or undocumented, undocumented immigrants fear deportation); health care system interactions (social isolation and change in hospital procedures, appreciation for clinicians and language access, and discharge with insufficient resources or clinical information); and faith and community resiliency (spirituality, Latinx COVID-19 advocates). CONCLUSIONS AND RELEVANCE In interviews, Latinx patients with COVID-19 who survived hospitalization described initial disease misinformation and economic and immigration fears as having driven exposure and delays in presentation. To confront COVID-19 as a compounder of social disadvantage, public health authorities should mitigate COVID-19-related misinformation, immigration fears, and challenges to health care access, as well as create policies that provide work protection and address economic disadvantages.

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Section: Introductionmentioning

confidence: 99%

“… 13 These circumstances have contributed to an excess burden of COVID-19 morbidity and mortality in the Latinx community. 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

Experiences of Latinx Individuals Hospitalized for COVID-19

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Section: Introductionmentioning

confidence: 99%

“…More deaths are occurring during the COVID-19 pandemic than predicted by historical trends [1-4]. In California, per-capita excess mortality is relatively high among Blacks, Latinos, and individuals with low educational attainment [4]. An explanation for these findings is that these populations face unique occupational risks because they may disproportionately make up the state’s essential workforce and because essential workers often cannot work from home [4-6].…”

Section: Introductionmentioning

confidence: 99%

Excess mortality associated with the COVID-19 pandemic among Californians 18–65 years of age, by occupational sector and occupation: March through October 2020

Chen

Glymour

Riley

et al. 2021

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BackgroundThough SARS-CoV-2 outbreaks have been documented in occupational settings and though there is speculation that essential workers face heightened risks for COVID-19, occupational differences in excess mortality have, to date, not been examined. Such information could point to opportunities for intervention, such as workplace modifications and prioritization of vaccine distribution.Methods and findingsUsing death records from the California Department of Public Health, we estimated excess mortality among Californians 18–65 years of age by occupational sector and occupation, with additional stratification of the sector analysis by race/ethnicity. During the COVID-19 pandemic, working age adults experienced a 22% increase in mortality compared to historical periods. Relative excess mortality was highest in food/agriculture workers (39% increase), transportation/logistics workers (28% increase), facilities (27%) and manufacturing workers (23% increase). Latino Californians experienced a 36% increase in mortality, with a 59% increase among Latino food/agriculture workers. Black Californians experienced a 28% increase in mortality, with a 36% increase for Black retail workers. Asian Californians experienced an 18% increase, with a 40% increase among Asian healthcare workers. Excess mortality among White working-age Californians increased by 6%, with a 16% increase among White food/agriculture workers.ConclusionsCertain occupational sectors have been associated with high excess mortality during the pandemic, particularly among racial and ethnic groups also disproportionately affected by COVID-19. In-person essential work is a likely venue of transmission of coronavirus infection and must be addressed through strict enforcement of health orders in workplace settings and protection of in-person workers. Vaccine distribution prioritizing in-person essential workers will be important for reducing excess COVID mortality.

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“…While prior research has documented significant racial and socioeconomic inequities in directly assigned Covid-19 deaths, 25–30 few studies have documented how excess mortality in 2020 has differed across sociodemographic or health factors. 31…”

Section: Introductionmentioning

confidence: 99%

Assessing the Impact of the Covid-19 Pandemic on US Mortality: A County-Level Analysis

Stokes

Lundberg

Hempstead

et al. 2020

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Covid-19 excess deaths refer to increases in mortality over what would normally have been expected in the absence of the Covid-19 pandemic. In this study, we take advantage of spatial variation in Covid-19 mortality across US counties to construct an Ordinary Least Squares regression model estimating its relationship with all-cause mortality. We then examine how the extent of excess mortality not assigned to Covid-19 varies across subsets of counties defined by demographic, structural, and policy characteristics. We estimate that 20.4% [95% CI (13.7%, 27.2%)] of excess deaths between February 1 and August 26, 2020 were ascribed to causes of death other than Covid-19 itself. Excess deaths not assigned to Covid-19 were even higher than predicted by our model in counties with high income inequality, low median income, low homeownership, and high percentages of Black residents, showing a pattern related to socioeconomic disadvantage and structural racism. Our work suggests that inequities in excess deaths attributable to Covid-19 may be even greater than revealed by data reporting deaths assigned to Covid-19 alone.

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Excess Mortality in California During the Coronavirus Disease 2019 Pandemic, March to August 2020

Abstract: This time-series analysis examines the excess number of deaths across population subgroups in California during the COVID-19 pandemic.

Cited by 52 publications

References 3 publications

Experiences of Latinx Individuals Hospitalized for COVID-19

Experiences of Latinx Individuals Hospitalized for COVID-19

Excess mortality associated with the COVID-19 pandemic among Californians 18–65 years of age, by occupational sector and occupation: March through October 2020

Assessing the Impact of the Covid-19 Pandemic on US Mortality: A County-Level Analysis

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