Racial and Ethnic Disparities in Age-Specific All-Cause Mortality During the COVID-19 Pandemic

• Published in: JAMA network open 2024-10, Vol.7 (10), p.e2438918
• Main Authors: Faust, Jeremy Samuel, Renton, Benjamin, Bongiovanni, Tasce, Chen, Alexander Junxiang, Sheares, Karen Dorsey, Du, Chengan, Essien, Utibe R, Fuentes-Afflick, Elena, Haywood, Trent, Khera, Rohan, King, Terris, Li, Shu-Xia, Lin, Zhenqiu, Lu, Yuan, Marshall, Andrew D A, Ndumele, Chima D, Opara, Ijeoma, Loarte-Rodriguez, Tina, Sawano, Mitsuaki, Taparra, Kekoa, Taylor, Herman A, Watson, Karol E, Yancy, Clyde W, Krumholz, Harlan M
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Cause of Death; Child; Child, Preschool; COVID-19; COVID-19 - ethnology; COVID-19 - mortality; Cross-Sectional Studies; Ethnicity; Female; Health Status Disparities; Humans; Infant; Male; Middle Aged; Minority & ethnic groups; Mortality; Mortality - ethnology; Mortality - trends; Native North Americans; Online Only; Original Investigation; Pacific Islander people; Pandemics; Public Health; Race; Racial Groups; Ratios; United States - epidemiology; Young Adult
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2024.38918

The end of the COVID-19 public health emergency (PHE) provides an opportunity to fully describe pandemic-associated racial and ethnic mortality disparities. Age-specific excess mortality differences have important downstream implications, especially in minoritized race and ethnicity populations. To characterize overall and age-specific all-cause excess mortality by race and ethnicity during the COVID-19 PHE and assess whether measured differences reflected changes from prepandemic disparities. This cross-sectional study analyzed data of all US residents and decedents during the COVID-19 PHE, aggregated by observed race and ethnicity (at time of death) and age. Statistical analysis was performed from March 2020 to May 2023. COVID-19 PHE period (March 2020 to May 2023). All-cause excess mortality (incident rates, observed-to-expected ratios) and all-cause mortality relative risks before and during the PHE. For the COVID-19 PHE period, data for 10 643 433 death certificates were available; mean (SD) decedent age was 72.7 (17.9) years; 944 318 (8.9%) were Hispanic; 78 973 (0.7%) were non-Hispanic American Indian or Alaska Native; 288 680 (2.7%) were non-Hispanic Asian, 1 374 228 (12.9%) were non-Hispanic Black or African American, 52 905 (0.5%) were non-Hispanic more than 1 race, 15 135 (0.1%) were non-Hispanic Native Hawaiian or Other Pacific Islander, and 7 877 996 (74.1%) were non-Hispanic White. More than 1.38 million all-cause excess deaths (observed-to-expected ratio, 1.15 [95% CI, 1.12-1.18]) occurred, corresponding to approximately 23 million years of potential life lost (YPLL) during the pandemic. For the total population (all ages), the racial and ethnic groups with the highest observed-to-expected all-cause mortality ratios were the American Indian or Alaska Native (1.34 [95% CI, 1.31-1.37]) and Hispanic (1.31 [95% CI, 1.27-1.34]) populations. However, higher ratios were observed in the US population aged 25 to 64 years (1.20 [95% CI, 1.18-1.22]), greatest among the American Indian or Alaska Native (1.45 [95% CI, 1.42-1.48]), Hispanic (1.40 [95% CI, 1.38-1.42]), and Native Hawaiian or Other Pacific Islander (1.39 [95% CI, 1.34-1.44]) groups. In the total population aged younger than 25 years, the Black population accounted for 51.1% of excess mortality, despite representing 13.8% of the population. Had the rate of excess mortality observed among the White population been observed among the total population, more than 252 000 (18.3%) fewer excess dea