Disproportionate Share of Pandemic-Associated Excess Deaths in 2020 Were Minorities

(Reuters Health) – During most of 2020, excess deaths in the U.S. – both COVID-19-related and not – occurred at higher rates among Black, Native American, and Latino men and women, a large new study finds.

An analysis of the 477,200 excess deaths in the U.S. from March through December 2020 revealed that age-standardized excess deaths per 100,000 persons among Black, American Indian/Alaska Native (AI/AN) and Latino individuals were more than twice as high, overall, than among white and Asian individuals. Among non-COVID-19 deaths, rates were two to four times higher in minority groups, according to the report published in the Annals of Internal Medicine.

“Studies have shown that racial/ethnic disparities in COVID-19 risk, hospitalization, and death can be attributed to structural and social determinants of health with established and deep roots in racism,” said the study’s first author, Meredith Shiels, a senior investigator in the division of cancer epidemiology and genetics at the National Cancer Institute.

“These findings warn us that there is likely to be a severe widening of racial/ethnic disparities in all-cause mortality as longer-term data are released,” Shiels added. “Equitable vaccine distribution is needed to prevent further exacerbation of racial/ethnic disparities in COVID-19 risk and mortality. Inequities need to be addressed with urgency and cultural competence, as has been done by tribal communities in vaccinating nearly 100% of their population. The disproportionate effect of the pandemic on Black, AI/AN, and Latino communities has been devastating and highlights the urgent need to address long-standing structural inequities.”

To take a closer look at potential disparities in excess deaths among minorities, Shiels and her colleagues turned to provisional data from the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics for March 1, 2020 to December 31, 2020, and compared all-cause mortality rates to the same months during 2019.

Shiels and her colleagues found that 2.88 million deaths occurred in the U.S. between March and December of 2020, of which an estimated 477,200 were excess deaths. Of these excess deaths in 2020, 74% were attributed to COVID-19.

All-cause mortality increased for all groups in 2020, but so did existing disparities. For example, the authors note, in 2019 age-standardized deaths per 100,000 were already 26% higher among Black males as compared with white males. In 2020, that rate was 45% higher among Black males.

For non-COVID-19 deaths specifically, age-standardized mortality was nine times higher among Black males in 2020, as compared with white males.

Overall, rates of excess death in Black, AI/AN, and Latino males and females were more than twice those in white and Asian males and females in 2020, the study found.

“Any doubts that structural racism is deadly should be swiftly erased by reading this article,” said Dr. Carol Horowitz, a professor of population health, and of medicine, and director of the Institute for Health Equity Research at the Icahn School of Medicine at Mount Sinai in New York City.

“The decades it took to begin to narrow the mortality gap between whites and Blacks were swiftly erased in one single year,” Dr. Horowitz said in an email. “Why? COVID disproportionately killed those with the least ability to withstand the disease – folks with low incomes, who must leave home to work, who live in more crowded housing, and whose earned skepticism of healthcare was compounded by propaganda fueling doubts about taking measures proven to prevent COVID deaths.”

“This article shows that this racial and ethnic carnage did not stop with the virus itself,” Dr. Horowitz said. “Non-white people began to die in excess rates from the same chronic diseases, like diabetes and heart disease, that put them at greater risk of dying from COVID. Systems and policy choices – not individual behaviors – created the problems that lead to these inequitable death rates. These research findings are a direct challenge for us to shore up our physical and social infrastructures to both prevent future waves of death and to serve the communities financially, socially and emotionally devastated by this unfathomable loss.”

While the finding that COVID-19 hit minorities harder than white people is not new, “the study adds a little precision to those estimates,” said Dr. Peter Muennig, a professor of health policy and management at Columbia University’s Mailman School of Public Health in New York City. “We knew for example that Black neighborhoods experienced more than twice as many deaths than white neighborhoods. But this paper makes a more concrete comparison.”

Minorities tend to dwell in smaller living spaces with multiple generations in a single home and that stresses associated with poverty cause people to age prematurely, Dr. Muennig said. Those types of things make minorities more susceptible to COVID-19, he added.

SOURCE: https://bit.ly/3BcFdj5 and https://bit.ly/3uGYl6g Annals of Internal Medicine, online October 4, 2021.

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