Study finds disparities in U.S. all-cause mortality during COVID-19 pandemic

Today is JAMA network opena research team led by General Brigham. report Total excess deaths in the United States during the COVID-19 pandemic have disproportionately affected several minority populations, with the largest relative increase among adults ages 25 to 64, the authors say. , said this suggests downstream effects will be persistent.

By analyzing all U.S. all-cause deaths associated with the COVID-19 public health emergency (March 2020 to May 2023), researchers found that We characterized overall and age-specific excess mortality rates. They also assessed whether the measured differences reflected changes due to pre-pandemic racial disparities.

The number of excess deaths is over 1.38 million

More than 1.38 million all-cause excess deaths occurred (actual-to-expected ratio 1.15), equivalent to approximately 23 million years of potential life lost (YPLL) during the pandemic. Excess deaths included approximately 9,000 Blacks (542,000YPLL), 6,000 Hispanics (395,000YPLL), 400 American Indians or Alaska Natives (AIANs, 24,000YPLL), and 100 Native Hawaiians and other Pacific Islanders (7,500 YPLL) were included.

The highest ratios of observed to expected mortality were in AIAN (1.31) and Hispanic populations (1.31). However, this ratio was highest among people aged 25 to 64 (1.20), especially among AIANs (1.45), Hispanics (1.40), and Native Hawaiians and other Pacific Islanders (1.39). .

The proportion of excess mortality exceeded the proportion of the AIAN, Black, and Native Hawaiian or other Pacific Islander populations. For example, among adults age 25 and older, Black people account for 51.1% of excess deaths despite only making up 13.8% of the population.

We observed increases in YPLL per capita and excess mortality rates for AIANs, Blacks, Hispanics, Native Hawaiians, or other Pacific Islanders compared to Asians and Whites, due to the average age of deaths and This reflects the fact that the median age is young. Excess deaths between ages 0 and 64 were more than 454,000 (32.9%), accounting for approximately 14.2 million (61.2%) of the total YPLL.

Pandemic exacerbates historic mortality disparities

If the excess mortality seen in whites had been observed in the entire population, excess deaths would have been reduced by more than 252,000 (18.3%) and the incidence of YPLL would have been reduced by more than 5.2 million (22.3%).

We believe that the pandemic has exacerbated historic mortality disparities that have long been understood to reflect hierarchies in the social determinants of health, structural inequalities, and racism. It has been demonstrated that it appears to be continuing today.

Adults 65 and older account for 67% of excess deaths in the U.S. population, but individuals younger than 65 account for the majority of excess deaths in AIAN and Native Hawaiian or other Pacific Island populations ( 60.5% and 70.3% respectively). .

The magnitude of excess mortality was greater both before and after the development of a COVID-19 vaccine, both overall and within age groups. Differences in all-cause mortality by race that had been established and largely stable before COVID-19 changed with the onset of the pandemic, with the racial groups studied increasing their relative risk of death since March 2020. It's getting expensive.

By the third year of the pandemic, relative mortality risks had returned to pre-pandemic levels, except for AIANs and Native Hawaiians or other Pacific Islanders.

“Importantly, the pandemic has sharpened historic mortality disparities that have long been understood and continue to reflect a hierarchy of social determinants of health, structural inequalities, and racism. Our evidence is that it appears to have gotten worse,” the study authors wrote.

Researchers said racial disparities cannot be explained by genetics alone. “Pandemics are inevitable, but inequality is not,” they write. “It is clear that we need to address the conditions that create health disparities before the next public health crisis occurs.”