Racial/Ethnic and Age Differences in the Direct and Indirect Effects of the COVID-19 Pandemic on US Mortality

Abstract

Objectives. To estimate the direct and indirect effects of the COVID-19 pandemic on overall, race/ethnicity‒specific, and age-specific mortality in 2020 in the United States. Methods. Using surveillance data, we modeled expected mortality, compared it to observed mortality, and estimated the share of “excess” mortality that was indirectly attributable to the pandemic versus directly attributed to COVID-19. We present absolute risks and proportions of total pandemic-related mortality, stratified by race/ethnicity and age. Results. We observed 16.6 excess deaths per 10 000 US population in 2020; 84% were directly attributed to COVID-19. The indirect effects of the pandemic accounted for 16% of excess mortality, with proportions as low as 0% among adults aged 85 years and older and more than 60% among those aged 15 to 44 years. Indirect causes accounted for a higher proportion of excess mortality among racially minoritized groups (e.g., 32% among Black Americans and 23% among Native Americans) compared with White Americans (11%). Conclusions. The effects of the COVID-19 pandemic on mortality and health disparities are underestimated when only deaths directly attributed to COVID-19 are considered. An equitable public health response to the pandemic should also consider its indirect effects on mortality. (Am J Public Health. 2022;112(1):154–164. https://doi.org/10.2105/AJPH.2021.306541 )

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Serving the public? A content analysis of COVID-19 public service announcements airing from March – December of 2020 in the U.S

“…( Grier and Bryant, 2005 ) The COVID-19 pandemic continues to disproportionately burden populations who have been systematically and historically marginalized. ( Zalla et al, 2022 , Karmakar et al, 2021 ) While health communication interventions alone are insufficient to address inequity (and in fact, could reinforce inequity if access to information is more readily available to higher-resourced groups ( Viswanath et al, 2012 ), PSAs can be one component of an equity-centered response, by providing easy-to-understand information, to broad or targeted audiences, and to counter the spread of misinformation by conveying accurate information from trusted sources. ( Wakefield et al, 2010 , Viswanath et al, 2020 )…”

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“…While the majority of studies have focused on COVID-19 infection rates, hospitalisations and deaths, the true toll of the pandemic extends beyond the direct morbidity and mortality from SARS-CoV-2 infection. By January 2022, over 1 million excess deaths occurred in the USA alone; while COVID-19 was documented as a primary or underlying cause for 901 422 deaths, an estimated 11% of excess deaths were indirectly related to COVID-19 infection 1 2. Globally, 2.5 million excess deaths were directly and indirectly attributed to COVID-19 from January 2020 to June 2021 in Organisation of Economic Co-operation and Development countries, representing a 16% increase in the expected number of deaths 3.…”