COVID-19 exacerbates racial and ethnic mortality disparities

Using death certificate data from the COVID-19 public health emergency period (March 2020 to May 2023), researchers found that over 1.38 million excess deaths occurred. found some notable mortality disparities among racial and ethnic minority patient populations. As patients aged 25 to 64 years. This is observed despite the presence of excess deaths across all racial and ethnic groups overall, and these findings mark a departure from disparities seen even before the pandemic. .

Survey results announced in JAMA network open,¹ Observed-to-expected ratios of incidence, mortality, and relative risk of all-cause mortality before and during public health emergencies are the main outcomes of interest in this cross-sectional study. Data from more than 10 million death certificates were available at the time of the authors' analysis, and they defined excess deaths based on previous research and modeling results.^{2, 3}

Races and ethnicities represented in this analysis were: non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic black or African American (black), Hispanic or Latino of any race. They were American, multiple non-Hispanic races, and non-Hispanic races. -Hispanic Native Hawaiian or Other Pacific Islander and non-Hispanic White, and age-specific mortality rates were calculated for <25 years, 25-64 years, and 65 years and older. Deaths that occurred in groups that reported more than one race were only included in the U.S. total. The mean (SD) age at death was 72.7 (17.9) years.

“Focusing on all-cause mortality provides a comprehensive view of the overall association between the pandemic and outcomes, including deaths directly caused by COVID-19 (including misclassified COVID-19 deaths). “We were able to capture the indirect effects of the pandemic (including deaths related to viral infections),” the study authors wrote. This includes populations that are frequently excluded from public reports and dashboards. ”

The lowest expected number of deaths was 12,225 (95% CI, 11,892 to 12,557) for the Native Hawaiian or Other Pacific Islander group, and the highest expected for the white group (7,028,654, 95% CI , 6,843,894 to 7,213,414 people). ). Overall, deaths among people reporting a White race/ethnicity (7,877,996 people, 74.1%) accounted for the highest number of deaths, followed by non-Hispanic Black or African American (1,374,228 people, 12.9%), Hispanic (944,318 people, 8.9%), followed by non-Hispanic black or African American. Hispanic Asian (288,680; 2.7%), Non-Hispanic American Indian or Alaska Native (78,973; 0.7%), Non-Hispanic Multiple Races (52,905; 0.5%), and Non-Hispanic Native Hawaiian or Other Pacific Islanders (15,135; 0.1%).

The COVID-19 public health emergency lasts from January 27, 2020 to May 11, 2023, and data from March 2020 to May 11, 2023 was used for this new analysis. , and found differences in mortality rates by age and race/ethnicity. |Image credit: © Colored Lights-stock.adobe.com

The 1.38 million observed excess deaths corresponded to an estimated 23 million years of potential life lost, with an observed to expected mortality ratio of 1.15 (95% CI, 1.12-1.18) . Across all races and ethnicities, observed-to-expected ratios were highest for patients who reported themselves as American Indian or Alaska Native and Hispanic: 1.34 (95% CI, 1.31-1.37) and 1.31. (95% CI, 1.27-1.34). ), the lowest proportions were observed in patients who reported white race (1.12; 95% CI, 1.09-1.15) or multiple races (1.12; 95% CI, 1.07-1.17).

Across all ages, the highest observed-to-expected ratio was for patients aged 25 to 64 years (1.20, 95% CI, 1.18-1.22), although some races/ethnicities were included in this analysis. It was even higher in groups. : 1.39 (95% CI, 1.34-1.44) for reporting Native Hawaiian or other Pacific Islander, 1.40 (95% CI, 1.38-1.42) for reporting Hispanic, and 1.45 (95%) CI, 1.42- 1.48) Reporters included American Indians or Alaska Natives. A death for a person between the ages of 25 and 64 represents approximately 13.1 years of potential life loss.

Drill down to a specific age group.

• For those under 25 years of age, the disparity in baseline mortality was highest (1.96; 95% CI, 1.94-1.97), and the largest increase in relative risk during the pandemic (2.31; 95% CI, 2.29-2.33) was observed in Black populations. It was seen in
• Those aged 25-64 had the highest pre-pandemic mortality disparity (1.64, 95% CI, 1.62-1.66) and the largest increase in relative risk (2.10, 95% CI, 2.08-2.13). were American Indians or Alaska Natives. .
• For those aged 65 years and older, the relative risk increased significantly from baseline in the two groups.
  • Black: 1.07 (95% CI, 1.07-1.07) to 1.11 (95% CI, 1.11-1.12)
  • Hispanic: 0.72 (95% CI, 0.71-0.72) to 0.79 (95% CI, 0.79-0.79)

The authors found that although blacks made up only 13.8% of the under-25 cohort, they accounted for 51.4% of excess deaths in that age group, and that the oldest patients in the study (over 65 years old), it emphasizes that there is a black population. The incidence of excess mortality was highest among patients aged 25 to 64 years, and the ratio of observed to expected mortality remained low for all races and ethnicities.

These findings add to the existing literature. Because, instead of adjusting for age or using standard ranges, the authors used age-stratified component excess mortality modeling, the data spanned the entire pandemic, compared pre-pandemic and pandemic periods, and This is because it was identified through analysis. The researchers wrote that causes of death other than COVID-19 were also increasing at the same time.

“We believe that the pandemic has exacerbated historic mortality disparities that have long been understood to reflect social determinants of health, structural inequalities, and hierarchies of racism.” “We have proven that this appears to be the case, and it continues to be so.” “Given that race and ethnicity are social constructs, the magnitude of these findings cannot be explained by genetic differences. Nevertheless, biological (and modifiable) mechanisms must be taken into account.”

They emphasized that the conditions that create health disparities need to be addressed before the next public health crisis, and that targeted efforts to protect high-risk groups need to be strengthened (e.g. evidence policies, resource allocation, and infrastructure development). It addresses systemic inequalities.

References

1. Fausto JS, Renton B, Bongiovanni T, et al. Racial and ethnic disparities by age account for all deaths during the COVID-19 pandemic. JAMA net open. 2024;7(10):e2438918. doi:10.1001/jamanetworkopen.2024.38918

2. Faust JS, Renton B, Chen AJ, et al. In states with high vaccination rates, all-cause excess deaths from COVID-19 cases and associated hospitalizations will be separated in late winter and spring 2022. medRxiv. July 12, 2022. doi:10.1101/2022.07.07.22277315

3. Faust JS, Du C, Liang C, et al. Excess deaths in Massachusetts during the delta and omicron waves of COVID-19. Japan Automobile Manufacturers Association. 2022;328(1):74-76. doi:10.1001/jama.2022.8045