Time Trends in Racial/Ethnic Differences in COVID-19 Infection and Mortality

Wong, Michelle S.; Haderlein, Taona P.; Yuan, Anita H.; Moy, Ernest; Jones, Kenneth T.; Washington, Donna L.

doi:10.3390/ijerph18094848

Cited by 20 publications

(22 citation statements)

References 25 publications

(37 reference statements)

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“…Additionally, we observed an increase in all-cause mortality among Hispanic VA users in July 2020. This increase among Hispanics coincided with the increased COVID-19 mortality observed in this group during July 2020 [14]. While all racial and ethnic groups showed an increase in the number of deaths monthly, our results indicate that Hispanics and Blacks had the highest percent changes overall as well as monthly.…”

Section: Discussionsupporting

confidence: 69%

“…Higher mortality rates among Black VA users could be due to both direct and indirect factors related to COVID-19. A study conducted by Wong et al (2021) among a subset of veterans who were tested for COVID-19 between March and November 2020, examined excess mortality at the VA during this period. They found a disparity in spring 2020 among Black VA users, which corroborates the observed increase in all-cause mortality among the same group during April 2020 that we found in this study [14].…”

Section: Discussionmentioning

confidence: 99%

“…A study conducted by Wong et al (2021) among a subset of veterans who were tested for COVID-19 between March and November 2020, examined excess mortality at the VA during this period. They found a disparity in spring 2020 among Black VA users, which corroborates the observed increase in all-cause mortality among the same group during April 2020 that we found in this study [14]. Additional factors, such as a heightened risk for obesity, diabetes, cardiovascular diseases, and high rate of venous thromboembolism (VTE,) among Black Veterans compared to White Veterans [15], combined with decreased hospitalizations at the VA for non-COVID-related causes during the first months of the pandemic [16], likely contributed to the observed increase in all-cause mortality rates among this group, especially during April 2020.…”

Section: Discussionmentioning

confidence: 99%

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Disparities in Excess, All-Cause Mortality among Black, Hispanic, and White Veterans at the U.S. Department of Veterans Affairs during the COVID-19 Pandemic

Lukowsky

Der‐Martirosian

Dobalian

2022

IJERPH

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Background: From 2019 to 2020, all-cause mortality in the U.S. increased, with most of the rise attributed to COVID-19. No studies have examined the racial disparities in all-cause mortality among U.S. veterans receiving medical care (VA users) at the U.S. Department of Veterans Affairs (VA) during the pandemic. Methods: In the present paper, we conduct a longitudinal study examining the differences in mortality among White, Black, and Hispanic veterans, aged 45 years and older, during the first, full year of the pandemic (March 2020–February 2021). We calculated the Standardized Mortality Rates (SMRs) per 100,000 VA users for each racial and ethnic group by age and gender. Results: The highest percentage increase between the number of deaths occurred between pre- and post-pandemic years (March 2020–February 2021 vs. March 2019–February 2020). For Hispanics, the all-cause mortality increased by 34%, while for Blacks, it increased by 32%. At the same time, we observed that an 18% increase in all-cause mortality occurred among Whites. Conclusion: Blacks and Hispanics were disproportionately affected by the COVID-19 pandemic, leading both directly and indirectly to higher all-cause mortality among these groups compared to Whites. Disparities in the all-cause mortality rates varied over time and across groups. Additional research is needed to examine which factors may account for the observed changes over time. Understanding those factors will permit the development of strategies to mitigate these disparities.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Disparities in Excess, All-Cause Mortality among Black, Hispanic, and White Veterans at the U.S. Department of Veterans Affairs during the COVID-19 Pandemic

Lukowsky

Der‐Martirosian

Dobalian

2022

IJERPH

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“…Periods correspond roughly to peaks and troughs in the pandemic. 31 , 32 While vaccines reduce COVID-19 severity, vaccination rates were uneven due to greater access barriers and vaccine hesitancy in some communities. 33…”

Section: Methodsmentioning

confidence: 99%

“…Age was categorical to account for the nonlinear hospitalization and age association and different age distributions by race and ethnicity in our sample. Periods correspond roughly to peaks and troughs in the pandemic . While vaccines reduce COVID-19 severity, vaccination rates were uneven due to greater access barriers and vaccine hesitancy in some communities…”

Section: Methodsmentioning

confidence: 99%

Inclusion of Race and Ethnicity With Neighborhood Socioeconomic Deprivation When Assessing COVID-19 Hospitalization Risk Among California Veterans Health Administration Users

2023

Self Cite

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ImportanceDespite complexities of racial and ethnic residential segregation (hereinafter referred to as segregation) and neighborhood socioeconomic deprivation, public health studies, including those on COVID-19 racial and ethnic disparities, often rely on composite neighborhood indices that do not account for residential segregation.ObjectiveTo examine the associations by race and ethnicity among California’s Healthy Places Index (HPI), Black and Hispanic segregation, Social Vulnerability Index (SVI), and COVID-19–related hospitalization.Design, Setting, and ParticipantsThis cohort study included veterans with positive test results for COVID-19 living in California who used Veterans Health Administration services between March 1, 2020, and October 31, 2021.Main Outcomes and MeasuresRates of COVID-19–related hospitalization among veterans with COVID-19.ResultsThe sample available for analysis included 19 495 veterans with COVID-19 (mean [SD] age, 57.21 [17.68] years), of whom 91.0% were men, 27.7% were Hispanic, 16.1% were non-Hispanic Black, and 45.0% were non-Hispanic White. For Black veterans, living in lower-HPI (ie, less healthy) neighborhoods was associated with higher rates of hospitalization (odds ratio [OR], 1.07 [95% CI, 1.03-1.12]), even after accounting for Black segregation (OR, 1.06 [95% CI, 1.02-1.11]). Among Hispanic veterans, living in lower-HPI neighborhoods was not associated with hospitalization with (OR, 1.04 [95% CI, 0.99-1.09]) and without (OR, 1.03 [95% CI, 1.00-1.08]) Hispanic segregation adjustment. For non-Hispanic White veterans, lower HPI was associated with more frequent hospitalization (OR, 1.03 [95% CI, 1.00-1.06]). The HPI was no longer associated with hospitalization after accounting for Black (OR, 1.02 [95% CI, 0.99-1.05]) or Hispanic (OR, 0.98 [95% CI, 0.95-1.02]) segregation. Hospitalization was higher for White (OR, 4.42 [95% CI, 1.62-12.08]) and Hispanic (OR, 2.90 [95% CI, 1.02-8.23]) veterans living in neighborhoods with greater Black segregation and for White veterans in more Hispanic-segregated neighborhoods (OR, 2.81 [95% CI, 1.96-4.03]), adjusting for HPI. Living in higher SVI (ie, more vulnerable) neighborhoods was associated with greater hospitalization for Black (OR, 1.06 [95% CI, 1.02-1.10]) and non-Hispanic White (OR, 1.04 [95% CI, 1.01-1.06]) veterans.Conclusions and RelevanceIn this cohort study of US veterans with COVID-19, HPI captured neighborhood-level risk for COVID-19–related hospitalization for Black, Hispanic, and White veterans comparably with SVI. These findings have implications for the use of HPI and other composite neighborhood deprivation indices that do not explicitly account for segregation. Understanding associations between place and health requires ensuring composite measures accurately account for multiple aspects of neighborhood deprivation and, importantly, variation by race and ethnicity.

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COVID-19 and All-Cause Mortality by Race, Ethnicity, and Age Across Five Periods of the Pandemic in the United States

Luck

Elo

Preston

et al. 2023

Popul Res Policy Rev

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Racial/ethnic and age disparities in COVID-19 and all-cause mortality during 2020 are well documented, but less is known about their evolution over time. We examine changes in age-specific mortality across five pandemic periods in the United States from March 2020 to December 2022 among four racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian) for ages 35+. We fit Gompertz models to all-cause and COVID-19 death rates by 5-year age groups and construct age-specific racial/ethnic mortality ratios across an Initial peak (Mar–Aug 2020), Winter peak (Nov 2020–Feb 2021), Delta peak (Aug–Oct 2021), Omicron peak (Nov 2021–Feb 2022), and Endemic period (Mar–Dec 2022). We then compare to all-cause patterns observed in 2019. The steep age gradients in COVID-19 mortality in the Initial and Winter peak shifted during the Delta peak, with substantial increases in mortality at working ages, before gradually returning to an older age pattern in the subsequent periods. We find a disproportionate COVID-19 mortality burden on racial and ethnic minority populations early in the pandemic, which led to an increase in all-cause mortality disparities and a temporary elimination of the Hispanic mortality advantage at certain age groups. Mortality disparities narrowed over time, with racial/ethnic all-cause inequalities during the Endemic period generally returning to pre-pandemic levels. Black and Hispanic populations, however, faced a younger age gradient in all-cause mortality in the Endemic period relative to 2019, with younger Hispanic and Black adults in a slightly disadvantageous position and older Black adults in a slightly advantageous position, relative to before the pandemic.

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Time Trends in Racial/Ethnic Differences in COVID-19 Infection and Mortality

Cited by 20 publications

References 25 publications

Disparities in Excess, All-Cause Mortality among Black, Hispanic, and White Veterans at the U.S. Department of Veterans Affairs during the COVID-19 Pandemic

Disparities in Excess, All-Cause Mortality among Black, Hispanic, and White Veterans at the U.S. Department of Veterans Affairs during the COVID-19 Pandemic

Inclusion of Race and Ethnicity With Neighborhood Socioeconomic Deprivation When Assessing COVID-19 Hospitalization Risk Among California Veterans Health Administration Users

COVID-19 and All-Cause Mortality by Race, Ethnicity, and Age Across Five Periods of the Pandemic in the United States

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