The unequal burden of the Covid-19 pandemic: Capturing racial/ethnic disparities in US cause-specific mortality

Abstract

Despite a growing body of literature focused on racial/ethnic disparities in Covid-19 mortality, few previous studies have examined the pandemic's impact on 2020 cause-specific mortality by race and ethnicity. This paper documents changes in mortality by underlying cause of death and race/ethnicity between 2019 and 2020. Using age-standardized death rates, we attribute changes for Black, Hispanic, and White populations to various underlying causes of death and show how these racial and ethnic patterns vary by age and sex. We find that although Covid-19 death rates in 2020 were highest in the Hispanic community, Black individuals faced the largest increase in all-cause mortality between 2019 and 2020. Exceptionally large increases in mortality from heart disease, diabetes, and external causes of death accounted for the adverse trend in all-cause mortality within the Black population. Within Black and White populations, percentage increases in all-cause mortality were similar for men and women, as well as for ages 25–64 and 65+. Among the Hispanic population, however, percentage increases in mortality were greatest for working-aged men. These findings reveal that the overall impact of the pandemic on racial/ethnic disparities in mortality was much larger than that captured by official Covid-19 death counts alone.

Reductions in US life expectancy during the COVID-19 pandemic by race and ethnicity: Is 2021 a repetition of 2020?

“…A comparison of cause-specific death rates between 2019 and 2020 indicates a net rise in mortality from non-COVID-19 causes in 2020, often referred to as “excess” deaths: increases in several causes (e.g., drug overdoses and other unintentional injuries, homicides, diabetes, heart disease) had a larger overall impact on life expectancy than decreases in other causes (e.g., cancer, Alzheimer’s disease, chronic lower respiratory diseases) (9–12). The increase in non-COVID-19 mortality was particularly pronounced in the Black population, leading to a reduction in life expectancy at birth that was one year larger than our estimate based only on COVID-19 deaths (9, 13). Given that the risk of COVID-19 fatality is increased in the presence of numerous co-morbidities (e.g., cancer, Alzheimer’s disease), mortality rates from some of these chronic diseases may have decreased because severely ill individuals, particularly those with compromised immune systems, succumbed to COVID-19 rather than their underlying condition.…”

“…Risk factors for COVID-19 infection and mortality, such as crowded living conditions, frontline jobs with high exposure to infection and low pay, dependence on public transportation, low access to quality healthcare, and high rates of select chronic conditions, still characterize these groups, suggesting continued racial/ethnic disparities in COVID-19 mortality (7)(8)(9)(10)(11). A strategically-targeted vaccine distribution had the potential to reduce racial/ethnic disparities in COVID-19 mortality in 2021 (12), but many individuals faced barriers to vaccination in the early months, including difficulty scheduling vaccine appointments online, lack of transportation to vaccination sites, and lack of time off work to get vaccinated and recover from side effects (13,14). The resulting inequitable vaccine distribution and uptake may have further exacerbated racial/ethnic disparities in COVID-19 mortality.…”

Significant impacts of the COVID-19 pandemic on race/ethnic differences in USA mortality

“…One year of pandemic-associated mortality nearly eliminated the Hispanic life expectancy advantage that was consistent over the 2010-2019 period. The declining Hispanic mortality advantage was predominantly driven by a greater concentration of COVID-19 deaths among working-age Hispanic people compared to the white population, a finding that has also been documented elsewhere (6,10). This is bolstered by our finding that lifespan inequality increased for the Hispanic population, indicating greater variability in ages at death among Hispanic people in the USA.…”

“…So far, research on the differential impact of the pandemic on mortality across race/ethnic groups has mainly relied on estimates of overall life expectancy (6,7,26,27) and standardized death rates (10). While life expectancy is a widely-used and important indicator for studying population health and mortality, it is an average measure which conceals population variability and inequality (28)(29)(30)(31).…”

Coronavirus disease 2019 pandemic: An opportunity for transformation, innovation, and advocacy

“…During the initial surge of the SARS‐CoV‐2 pandemic, these groups were disproportionately impacted and changes in employment resulted in the loss of insurance coverage for many. 7 , 8 The closure of dental and dental hygiene students’ clinics disrupted preventive and ongoing care for patients most in need. Providing ongoing periodontal therapy for diabetic patients is extremely beneficial to helping regulate their diabetes and it is not uncommon for oral cancer and other pathologies to be diagnosed during a routine dental visit.…”