How did the COVID-19 pandemic alter racial and ethnic disparities in mortality?

By Neha MathurReviewed by Danielle Ellis, B.Sc.Sep 22 2022

In a recent study published in PNAS, researchers pursued evidence of all-cause mortality disparities during the coronavirus disease 2019 (COVID-19) pandemic in the United States (US), its temporal evolution, and whether this disparity persists.

Background

Increases in all-cause mortality in the first year of the COVID-19 pandemic were more in the Blacks and Hispanics than in White groups, or the indirect effects on mortality were higher in racially minor groups in 2020. Although these disparities may have reduced in 2021, there is a lack of data on how mortality disparities evolved and affected different racial and ethnic groups in the US and whether disparities have come back to pre-pandemic levels or established a new baseline.

A comprehensive assessment of all-cause mortality disparities during the COVID-19 pandemic is important because if they vary over time, it indicates their malleability, responsiveness to fluctuations in the pandemic, and social response to the pandemic.

It is also highly likely that the deep-rooted structural racism and preexisting disparities associated with mortality in the US worsened during the COVID-19 pandemic. For instance, minoritized groups experienced financial hardships and housing instability. Moreover, they remained at higher risk of job loss and subsequently lost health insurance during the COVID-19 pandemic.

About the study

In the present study, researchers estimated all-cause mortality in the US for seven ethnicities between January 2018 and February 2022, encompassing the first two years of the COVID-19 pandemic. Perhaps, the pandemic altered racial and ethnic mortality disparities in the short term, and these disparities varied across groups.

The researchers estimated the age-stratified death rate ratios of the White individuals and six other racial and ethnic groups in the US. These ethnicities were American Indian or Alaska Native (AIAN), Native Hawaiian or other Pacific Islander (NHOPI), Blacks, Asians, and Hispanics. In other words, they analyzed monthly dynamics of the all-cause relative mortality disparities between the White population, chosen as a reference because of the advantages they enjoy as a race in the US, and six other races and how it unfolded throughout the pandemic.

The researchers used up to nine joint point regression models to estimate temporal trends in the death rate ratios. They extracted the death data stratified by age group (less than and more than 65 years) using the Centers for Disease Control and Prevention’s (CDC) wide-ranging online data for epidemiologic research (WONDER) platform.

Study findings

Seasonal variations remained similar across groups, and their racial and ethnic mortality disparities were stable before the pandemic. However, during the COVID-19 pandemic, especially during the 2020-2021 wave, all-cause mortality increased in all seven racial and ethnic groups examined in the study.

Before the pandemic, Blacks of all ages had 1.19 times the mortality rate of White individuals. Their mortality rate ratio peaked at 1.77 in April 2020 and reached a transient dip of 1.10 in December 2021. The Black-White relative mortality disparity attained pre-pandemic levels by February 2022, indicating both Blacks and Whites had elevated absolute mortality during the pandemic.

Before the pandemic, Hispanics of all ages had lower all-cause mortality than White people. However, during the COVID-19 pandemic, the age-standardized all-cause mortality rate of Hispanic people exceeded that of Whites in April 2020, July 2020, and January 2021, for a total of three months. Asian Americans of all ages had a reduced mortality advantage relative to Whites, with all-cause mortality rate ratios of 0.72 in April 2020 and 0.68 in January 2021.

The largest surge of disparities relative to White people occurred among AIAN and NHOPIs under age 65. Notably, AIAN and NHOPIs had observed death rate ratios of up to 2.25 and 2.12 compared to pre-pandemic mean death rate ratios of 1.74 and 1.31, respectively.

Conclusions

The current study examined the mortality disparity trends relative to changing mortality rates in the White population. Thus, the observed reductions or surges in a few groups might be partially due to changes in the pattern of COVID-19-related mortalities in the White population. Nevertheless, the results showed that racial and ethnicity-related mortality disparities among Whites and six other groups worsened with the onset of the COVID-19 pandemic, with most extremes occurring during the COVID-19 waves.

Compared to the White population, mortality increased more for nearly all six racial groups. However, the researchers observed heterogeneity in the extent to which these evolved after the first year of the COVID-19 pandemic.

Unfortunately, for AIAN and NHOPIs, mortality disparities remained exacerbated above pre-pandemic levels even after two years into the pandemic, especially among those under 65 years, while COVID-19 deaths in Hispanic and Asian populations remained stable. These mortality disparities were unprecedented but could be reduced with long-term interventions, such as assured basic income programs, giving subsidized childcare, healthcare, and housing facilities, as well as short-term interventions, such as targeted vaccination campaigns for racial and ethnic minority groups.

Overall, the government needs to roll out new policies and community investments to address race and ethnicity-related mortality disparities in the US.