Findings highlight urgent need to address structural inequities, researchers say

Age-adjusted excess deaths among Black, American Indian/Alaskan Native, and Latino men and women in the United States were more than double those reported among Whites and Asians during the early months of the Covid-19 pandemic, new research found.

Investigators used surveillance data from provisional death certificates along with population estimates from the U.S. Census Bureau to assess excess deaths between March and December of 2020.

The findings highlight “profound racial/ethnic disparities” in excess deaths during the period, wrote researcher Meredith Shiels, PhD, of the National Cancer Institute in Rockville, Maryland, and colleagues. Their study was published online Oct. 4 in Annals of Internal Medicine.

“These findings portend severe widening of racial/ethnic disparities in all-cause mortality as longer-term data are released,” they wrote.

Shiels and colleagues noted that while racial and ethnic disparities in Covid-19 deaths have been well documented in previous research, most studies have examined Covid-19 deaths alone. Examining deaths both directly and indirectly related to the pandemic, they contended, more accurately reflects the impact of these racial and ethnic disparities on mortality during the Covid-19 pandemic.

The researchers analyzed racial and ethnic disparities in excess deaths attributed to Covid-19 and non–Covid-19 causes, including Alzheimer disease, heart disease, cerebrovascular disease, diabetes, cancer, and other causes. They then estimated excess deaths as observed deaths minus expected deaths from March through December 2020 by cause of death, race/ethnicity, sex, age group, and month.

“The expected number of deaths in 2020 was estimated by applying the cause-specific, race/ethnicity–specific, sex-specific, age group–specific, and month-specific deaths divided by population size in 2019 to population counts in 2020,” Shiels and colleagues wrote. “Expected deaths are the number of deaths that would have occurred in 2020 if age-specific deaths divided by the population size had been the same as in 2019. To account for population decreases caused by excess deaths in preceding months, the sum of excess deaths from all prior months was subtracted from the population estimates in each month of interest. This approach adjusted for population growth and aging as well as population decreases due to excess deaths in 2020.”

Of the 2.88 million deaths that occurred in the U.S. from March to December 2020, 477,200 were identified as excess deaths, and 74% of these deaths (n=351,400) were attributed to Covid-19.

The analysis revealed that all-cause mortality per 100,000 persons increased for all racial/ethnic groups in both males and females between 2019 and 2020.

Among the other main findings:

  • Disparities in age-standardized deaths per 100,000 persons increased for Black and AI/AN males and females compared with White males and females.
  • Excess mortality among Black males was 26% higher in 2019 and 45% higher in 2020 than among White males.
  • Excess mortality among Black females was 15% higher in 2019 and 32% higher in 2020 than among White females.
  • Of the estimated 477,200 excess deaths occurring during the period, compared to the same period in 2019, age-standardized excess deaths per 100,000 persons were 2 to 3 times higher among Black, AI/AN and Latinos than among Whites and Asians.
  • The disparities were clearly evident in those individuals age 75 or older—in this group, non-Covid-19 excess deaths among Black males in 2020 were 9 times higher than among White males.

In commentary published with the study, Yvonne Commodore-Mensah, PhD, and Lisa Cooper, MD, of Johns Hopkins Bloomberg School of Public Health, Baltimore, wrote that the Covid-19 pandemic has clearly “widened existing racial and ethnic disparities in all-cause mortality.”

“These data are even more troubling when we consider that such disparities have persisted for decades,” they wrote. “Although the life expectancy gap between Black and White persons decreased from 8 years in 1950 to 4 years by 2015, it took 40 years (1990) for Black persons to achieve the life expectancy that White persons had in 1950. The current analysis reveals that the pandemic has rapidly reversed the gains that were made at a slow and painful pace, at a time when experts have called for accelerated efforts to close racial gaps in health in the United States.”

Commodore-Mensah and Cooper called on researchers and public health professionals to conduct longitudinal studies and “monitor all-cause and cause specific mortality data by race/ethnicity at the national, regional and local levels.”

“These efforts may provide insights into the effects of the pandemic on health disparities and actions needed to mitigate the incidence of and morbidity from long-term sequelae of Covid-19 and other chronic conditions in communities of color,” they wrote.

They also called on federal lawmakers to pass the federal infrastructure bill, “which increases access to lead-free drinking water and affordable and reliable broadband, expands home- and community-based services, and extends many Affordable Care Act expansions from the American Rescue Plan.”

“However, we also need policies that will comprehensively address structural inequities for those who have experienced the most harm from the pandemic,” they concluded. “Only then will we meet this moment, turn the tide of excess deaths in people of color in the United States, and begin to close the gap between where we are today and our vision of health equity, where everyone has a fair and just opportunity to be as healthy as possible.”

  1. Age-adjusted excess deaths among Black, American Indian/Alaskan Native, and Latino men and women in the United States were more than double those reported among Whites and Asians during the early months of the Covid-19 pandemic.

  2. Of the 2.88 million deaths that occurred in the U.S. between March and December 2020, 477,200 were identified as excess deaths, and 74% of these deaths were attributed to Covid-19.

Salynn Boyles, Contributing Writer, BreakingMED™

This research was funded by the National Cancer Institute and the National Institute on Minority Health and Health Disparities.

Shiels disclosed no relative relationships.

Commodore-Mensah disclosed no relevant relationships.

Cooper disclosed relevant relationships with various universities, NIH, the Patient-Centered Outcomes Research Institute, Merck Foundation, Aetna/CVS Health, West Africa — PREVAC, the Covid-19 Vaccine Data and Safety Monitoring Board, NIAID), Pfizer, the Carter Center and others.

Cat ID: 288

Topic ID: 278,288,288,585,730,933,125,926,192,927,151,928,925,934