A comprehensive analysis of US mortality data reveals significant racial and ethnic disparities in excess deaths during the COVID-19 public health emergency, with the greatest relative increases occurring among adults aged 25 to 64.
Summary: A cross-sectional study examining US mortality data during the COVID-19 pandemic found over 1.38 million excess deaths, with disproportionate impacts on minoritized populations. The research highlights how the pandemic amplified existing health disparities, particularly among working-age adults.
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The COVID-19 pandemic laid bare the stark health inequalities that persist in the United States, according to a new study published in JAMA Network Open. Researchers analyzed mortality data spanning the entire US COVID-19 public health emergency, uncovering significant disparities in excess deaths across racial and ethnic groups, with particularly concerning trends among younger and working-age adults.
Key Findings: Disparities Across Age Groups
The study, led by Dr. Jeremy Samuel Faust of Brigham and Women’s Hospital, examined data from over 10.6 million death certificates, revealing more than 1.38 million excess deaths during the pandemic period. While all racial and ethnic groups experienced increased mortality, the impacts were far from equal.
Among the key findings:
- The highest observed-to-expected mortality ratios were found in the non-Hispanic American Indian or Alaska Native (1.34) and Hispanic (1.31) populations.
- The greatest relative increases in mortality occurred in the 25-64 age group across all racial and ethnic categories.
- In the population under 25, Black individuals accounted for 51.1% of excess mortality, despite representing only 13.8% of that age group.
- Had the excess mortality rate of the White population been applied across all groups, over 252,000 fewer deaths and 5.2 million fewer years of potential life lost would have occurred.
“These results suggest that the COVID-19 PHE disproportionately affected several minoritized racial and ethnic groups; the largest relative increases occurred in the population aged 25 to 64 years, implying lasting downstream consequences,” the researchers noted.
Pandemic Amplified Existing Disparities
A crucial aspect of the study was its examination of how the pandemic affected pre-existing mortality disparities. By comparing pre-pandemic and pandemic mortality rates, the researchers found that in many cases, the COVID-19 emergency exacerbated already present inequalities.
For instance, among American Indian or Alaska Native populations, the relative risk of mortality compared to White populations increased from 1.07 before the pandemic to 1.22 during the pandemic. Similarly, for Black populations, this risk increased from 1.19 to 1.26.
The Hispanic population, which historically had lower mortality rates compared to White and Asian populations, saw this advantage narrow and even reverse during COVID-19 surges.
Beyond COVID-19: Indirect Impacts
While COVID-19 deaths correlated strongly with overall excess mortality, the study also found increases in deaths from other causes, particularly among younger age groups. These included rises in deaths from external causes such as homicide and unintentional overdoses, highlighting the pandemic’s far-reaching societal impacts.
Dr. Faust and colleagues emphasized that these disparities cannot be explained by genetic differences, as race and ethnicity are social constructs. Instead, they point to a complex interplay of factors, including:
- Higher rates of pre-existing conditions associated with poor COVID-19 outcomes in certain populations
- Increased viral exposure risk due to higher proportions of essential workers
- Disparities in healthcare access and quality
- Initial vaccine hesitancy related to historical medical mistrust
Implications for Future Preparedness
The study’s findings underscore the urgent need for targeted interventions and policy changes to address systemic inequalities in health outcomes. The researchers argue that preparing for future pandemics must include efforts to protect high-risk groups through evidence-based policies, equitable resource distribution, and improved infrastructure.
“While pandemics are inevitable, disparities are not,” the study concludes. “The need to address the conditions that create health disparities—before the next public health crisis—is evident.”
Quiz: Test Your Knowledge
- Which age group experienced the highest relative increase in all-cause mortality across all racial and ethnic groups?
- What percentage of excess deaths could have been avoided if all groups had experienced the same mortality rate as the White population?
- How did the pandemic affect the historically lower mortality rates of the Hispanic population compared to White and Asian populations?
Answers:
- Adults aged 25 to 64 years
- 18.3% (over 252,000 fewer deaths)
- The advantage narrowed and even reversed during COVID-19 surges
Glossary of Terms
- Excess Mortality: The number of deaths from all causes during a crisis above and beyond what would have been expected under normal conditions.
- Public Health Emergency (PHE): A formal declaration that allows federal agencies to take special measures to address a significant health threat.
- Years of Potential Life Lost (YPLL): A measure of premature mortality that estimates the average years a person would have lived if they had not died prematurely.
- Observed-to-Expected Mortality Ratio: A comparison of the actual number of deaths to the number that would have been expected based on historical data.
- Relative Risk (RR): A ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group.
- Social Determinants of Health: The conditions in which people are born, grow, live, work, and age that affect health outcomes.
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