Variation in racial/ethnic disparities in COVID-19 mortality by age in the United States: A cross-sectional study

Author summaryWhy was this study done? Data from media coverage and local health department reports suggest that, as compared to the non-Hispanic White population, COVID-19 mortality rates are substantially higher among non-Hispanic Black, Hispanic, and non-Hispanic American Indian or Alaska Native populations. But no national data have been available to determine whether, in addition to dying at higher rates, these groups also die at younger ages. What did the researchers do and find? Using recently released national data on COVID-19 deaths by racial/ethnic group and age, along with US Census population data, we explored variation in mortality risk by calculating age-specific mortality measures in the above groups as well as in the non-Hispanic Asian or Pacific Islander population, the 5 census-defined groups for which data are available. We found that for all groups, as compared to the non-Hispanic White population, there were excess COVID-19 deaths across all ages. Although for all racial/ethnic groups, most deaths occurred at older ages, there was also striking loss of life at younger ages, before age 65, among people of color. More years of life were lost before 65 years among the non-Hispanic Black and Hispanic populations, despite the smaller size of these groups, than among the non-Hispanic White population. Scrutinizing age-specific mortality rates, we found that for young adults into midlife, comparatively, the non-Hispanic Black, Hispanic, and non-Hispanic American Indian or Alaska Native populations had a much higher risk of death from COVID-19 than the non-Hispanic White population. What do these findings mean? These data support the conclusion that US populations of color die of COVID-19 at younger ages as well as at higher rates than the non-Hispanic White population. Enhancing protection from infection, including assurance of workplace protections, may be relevant to prevention of COVID-19 in working-age adults. Background In the United States, non-Hispanic Black (NHB), Hispanic, and non-Hispanic American Indian/Alaska Native (NHAIAN) populations experience excess COVID-19 mortality, compared to the non-Hispanic White (NHW) population, but racial/ethnic differences in age at death are not known. The release of national COVID-19 death data by racial/ethnic group now permits analysis of age-specific mortality rates for these groups and the non-Hispanic Asian or Pacific Islander (NHAPI) population. Our objectives were to examine variation in age-specific COVID-19 mortality rates by racial/ethnicity and to calculate the impact of this mortality using years of potential life lost (YPLL). Methods and findings This cross-sectional study used the recently publicly available data on US COVID-19 deaths with reported race/ethnicity, for the time period February 1, 2020, to July 22, 2020. Population data were drawn from the US Census. As of July 22, 2020, the number of COVID-19 deaths equaled 68,377 for NHW, 29,476 for NHB, 23,256 for Hispanic, 1,143 for NHAIAN, and 6,468 for NHAPI populations; the corresponding population sizes were 186.4 million, 40.6 million, 2.6 million, 19.5 million, and 57.7 million. Age-standardized rate ratios relative to NHW were 3.6 (95% CI 3.5, 3.8;p <0.001) for NHB, 2.8 (95% CI 2.7, 3.0;p <0.001) for Hispanic, 2.2 (95% CI 1.8, 2.6;p <0.001) for NHAIAN, and 1.6 (95% CI 1.4, 1.7;p <0.001) for NHAP populations. By contrast, NHB rate ratios relative to NHW were 7.1 (95% CI 5.8, 8.7;p <0.001) for persons aged 25-34 years, 9.0 (95% CI 7.9, 10.2;p <0.001) for persons aged 35-44 years, and 7.4 (95% CI 6.9, 7.9;p <0.001) for persons aged 45-54 years. Even at older ages, NHB rate ratios were between 2.0 and 5.7. Similarly, rate ratios for the Hispanic versus NHW population were 7.0 (95% CI 5.8, 8.7;p <0.001), 8.8 (95% CI 7.8, 9.9;p <0.001), and 7.0 (95% CI 6.6, 7.5;p <0.001) for the corresponding age strata above, with remaining rate ratios ranging from 1.4 to 5.0. Rate ratios for NHAIAN were similarly high through age 74 years. Among NHAPI persons, rate ratios ranged from 2.0 to 2.8 for persons aged 25-74 years and were 1.6 and 1.2 for persons aged 75-84 and 85+ years, respectively. As a consequence, more YPLL before age 65 were experienced by the NHB and Hispanic populations than the NHW population-despite the fact that the NHW population is larger-with a ratio of 4.6:1 and 3.2:1, respectively, for NHB and Hispanic persons. Study limitations include likely lag time in receipt of completed death certificates received by the Centers for Disease Control and Prevention for transmission to NCHS, with consequent lag in capturing the total number of deaths compared to data reported on state dashboards. Conclusions In this study, we observed racial variation in age-specific mortality rates not fully captured with examination of age-standardized rates alone. These findings suggest the importance of examining age-specific mortality rates and underscores how age standardization can obscure extreme variations within age strata. To avoid overlooking such variation, data that permit age-specific analyses should be routinely publicly available.