Geographic and Temporal Patterns in Covid-19 Mortality by Race and Ethnicity in the United States from March 2020 to February 2022

Abstract

Prior research has established that American Indian, Alaska Native, Black, Hispanic, and Pacific Islander populations in the United States have experienced substantially higher mortality rates from Covid-19 compared to non-Hispanic white residents during the first year of the pandemic. What remains less clear is how mortality rates have changed for each of these racial/ethnic groups during 2021, given the increasing prevalence of vaccination. In particular, it is unknown how these changes in mortality have varied geographically. In this study, we used provisional data from the National Center for Health Statistics (NCHS) to produce age-standardized estimates of Covid-19 mortality by race/ethnicity in the United States from March 2020 to February 2022 in each metro-nonmetro category, Census region, and Census division. We calculated changes in mortality rates between the first and second years of the pandemic and examined mortality changes by month. We found that when Covid-19 first affected a geographic area, non-Hispanic Black and Hispanic populations experienced extremely high levels of Covid-19 mortality and racial/ethnic inequity that were not repeated at any other time during the pandemic. Between the first and second year of the pandemic, racial/ethnic inequities in Covid-19 mortality decreased—but were not eliminated—for Hispanic, non-Hispanic Black, and non-Hispanic AIAN residents. These inequities decreased due to reductions in mortality for these populations alongside increases in non-Hispanic white mortality. Though racial/ethnic inequities in Covid-19 mortality decreased, substantial inequities still existed in most geographic areas during the pandemic’s second year: Non-Hispanic Black, non-Hispanic AIAN, and Hispanic residents reported higher Covid-19 death rates in rural areas than in urban areas, indicating that these communities are facing serious public health challenges. At the same time, the non-Hispanic white mortality rate worsened in rural areas during the second year of the pandemic, suggesting there may be unique factors driving mortality in this population. Finally, vaccination rates were associated with reductions in Covid-19 mortality for Hispanic, non-Hispanic Black, and non-Hispanic white residents, and increased vaccination may have contributed to the decreases in racial/ethnic inequities in Covid-19 mortality observed during the second year of the pandemic. Despite reductions in mortality, Covid-19 mortality remained elevated in nonmetro areas and increased for some racial/ethnic groups, highlighting the need for increased vaccination delivery and equitable public health measures especially in rural communities. Taken together, these findings highlight the continued need to prioritize health equity in the pandemic response and to modify the structures and policies through which systemic racism operates and has generated racial health inequities.

Monthly excess mortality across counties in the United States during the Covid-19 pandemic, March 2020 to February 2022

“…A prior study found that increases in Covid-19 mortality in nonmetro areas during the second year of the pandemic were largely driven by increases in mortality among non-Hispanic white populations. 31 In line with this, a survey from 2021 found that white, older individuals who identified as Republican were the most vaccine hesitant population in the U.S.. 32 Another factor that may be contributing to high rural excess mortality is insufficient rural health infrastructure related to funding gaps and workforce shortages. 33 This may have affected access to Covid-19 treatment, including oral antivirals and monoclonal antibody treatments.…”

Heterogeneity in Damages from A Pandemic

“…Our findings also contribute to a broader literature examining the relationship between economic conditions and health. This literature has highlighted the complex ways in which aggregate-level economic downturns and individual-level job losses may impact health (Ruhm 2000;2005;Sullivan and Von Wachter 2009;Ruhm 2015;Stevens et al 2015), and, conversely, how shocks to population health may impact the economy (Adda 2016;Barro et al 2020; mortality rates (Bassett et al 2020;Ford et al 2020); these gaps declined but were not eliminated during the pandemic's second year (Aschmann et al 2022;Lundberg et al 2022;Truman et al 2022). Minorities also experienced greater all-cause mortality during the pandemic's initial months (Alsan et al 2021;Miller et al 2021;Polyakova et al 2021), and these gaps persisted through the pandemic's first year (Cronin and Evans 2021;Ruhm 2022;Foster et al 2022).…”

Prevalence and Assessment of Factors Associated with COVID-19 Vaccine Hesitancy in an Ethnic Minority Oncology Patient Population

“…However, a recent study in 2022 showed that although there are now higher vaccination rates among non-Hispanic Blacks and Hispanics, which have reduced mortality, there remains a high disparity in mortality between these ethnic groups and non-Hispanic Whites [ 57 ]. Despite these high vaccination rates, as many as 10% of adults are unvaccinated and if they have cancer can have a higher risk of mortality than a vaccinated cancer patient.…”