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

Jeremy Samuel Faust; Benjamin Renton; Tasce Bongiovanni; Alexander Junxiang Chen; Karen Dorsey Sheares; Chengan Du; Utibe R. Essien; Elena Fuentes-Afflick; Trent Haywood; Rohan Khera; Terris King; Shu Xia Li; Zhenqiu Lin; Yuan Lu; Andrew D.A. Marshall; Chima D. Ndumele; Ijeoma Opara; Tina Loarte-Rodriguez; Mitsuaki Sawano; Kekoa Taparra; Herman A. Taylor; Karol E. Watson; Clyde W. Yancy; Harlan M. Krumholz

doi:10.1001/jamanetworkopen.2024.38918

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

Jeremy Samuel Faust^*, Benjamin Renton, Tasce Bongiovanni, Alexander Junxiang Chen, Karen Dorsey Sheares, Chengan Du, Utibe R. Essien, Elena Fuentes-Afflick, Trent Haywood, Rohan Khera, Terris King, Shu Xia Li, Zhenqiu Lin, Yuan Lu, Andrew D.A. Marshall, Chima D. Ndumele, Ijeoma Opara, Tina Loarte-Rodriguez, Mitsuaki Sawano, Kekoa TaparraHerman A. Taylor, Karol E. Watson, Clyde W. Yancy, Harlan M. Krumholz

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

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Abstract

Importance: 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. Objectives: 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. Design, Setting, and Participants: 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. Exposures: COVID-19 PHE period (March 2020 to May 2023). Main Outcomes and Measures: All-cause excess mortality (incident rates, observed-To-expected ratios) and all-cause mortality relative risks before and during the PHE. Results: For the COVID-19 PHE period, data for 10643433 death certificates were available; mean (SD) decedent age was 72.7 (17.9) years; 944318 (8.9%) were Hispanic; 78973 (0.7%) were non-Hispanic American Indian or Alaska Native; 288680 (2.7%) were non-Hispanic Asian, 1374228 (12.9%) were non-Hispanic Black or African American, 52905 (0.5%) were non-Hispanic more than 1 race, 15135 (0.1%) were non-Hispanic Native Hawaiian or Other Pacific Islander, and 7877996 (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 252000 (18.3%) fewer excess deaths and more than 5.2 million (22.3%) fewer YPLL would have occurred. Conclusions and Relevance: In this cross-sectional study of the US population during the COVID-19 PHE, excess mortality occurred in all racial and ethnic groups, with disparities affecting several minoritized populations. The greatest relative increases occurred in populations aged 25 to 64 years. Documented differences deviated from prepandemic disparities.

Original language	English (US)
Pages (from-to)	e2438918
Journal	JAMA network open
Volume	7
Issue number	10
DOIs	https://doi.org/10.1001/jamanetworkopen.2024.38918
State	Published - Oct 11 2024

Funding

Conflict of Interest Disclosures: Dr Khera reported being an academic cofounder of Evidence2Health and of Ensight-AI; receiving grants from Bristol Myers Squibb through Yale, grants from Novo Nordisk through Yale, and grants from BridgeBio through Yale outside the submitted work. Dr Lu reported grants from the National Institutes of Health, Patient-Centered Outcomes Research Institute, and the Sentara Research Foundation outside the submitted work. Dr Sawano reported grants from Pfizer and Polybio outside the submitted work. Dr Yancy reported spousal salary from Abbott Labs. Dr Krumholz reported receiving options for Element Science and Identifeye and payments from F-Prime for advisory roles; he is a cofounder of and holds equity in Hugo Health, Refactor Health, and ENSIGHT-AI; and he received through Yale University research contracts from Janssen, Kenvue, Novartis, and Pfizer. No other disclosures were reported.

ASJC Scopus subject areas

General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1001/jamanetworkopen.2024.38918

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Faust, J. S., Renton, B., Bongiovanni, T., Chen, A. J., Sheares, K. D., Du, C., Essien, U. R., Fuentes-Afflick, E., Haywood, T., Khera, R., King, T., Li, S. X., Lin, Z., Lu, Y., Marshall, A. D. A., Ndumele, C. D., Opara, I., Loarte-Rodriguez, T., Sawano, M., ... Krumholz, H. M. (2024). Racial and Ethnic Disparities in Age-Specific All-Cause Mortality during the COVID-19 Pandemic. JAMA network open, 7(10), e2438918. https://doi.org/10.1001/jamanetworkopen.2024.38918

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title = "Racial and Ethnic Disparities in Age-Specific All-Cause Mortality during the COVID-19 Pandemic",

abstract = "Importance: 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. Objectives: 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. Design, Setting, and Participants: 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. Exposures: COVID-19 PHE period (March 2020 to May 2023). Main Outcomes and Measures: All-cause excess mortality (incident rates, observed-To-expected ratios) and all-cause mortality relative risks before and during the PHE. Results: For the COVID-19 PHE period, data for 10643433 death certificates were available; mean (SD) decedent age was 72.7 (17.9) years; 944318 (8.9%) were Hispanic; 78973 (0.7%) were non-Hispanic American Indian or Alaska Native; 288680 (2.7%) were non-Hispanic Asian, 1374228 (12.9%) were non-Hispanic Black or African American, 52905 (0.5%) were non-Hispanic more than 1 race, 15135 (0.1%) were non-Hispanic Native Hawaiian or Other Pacific Islander, and 7877996 (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 252000 (18.3%) fewer excess deaths and more than 5.2 million (22.3%) fewer YPLL would have occurred. Conclusions and Relevance: In this cross-sectional study of the US population during the COVID-19 PHE, excess mortality occurred in all racial and ethnic groups, with disparities affecting several minoritized populations. The greatest relative increases occurred in populations aged 25 to 64 years. Documented differences deviated from prepandemic disparities.",

author = "Faust, {Jeremy Samuel} and Benjamin Renton and Tasce Bongiovanni and Chen, {Alexander Junxiang} and Sheares, {Karen Dorsey} and Chengan Du and Essien, {Utibe R.} and Elena Fuentes-Afflick and Trent Haywood and Rohan Khera and Terris King and Li, {Shu Xia} and Zhenqiu Lin and Yuan Lu and Marshall, {Andrew D.A.} and Ndumele, {Chima D.} and Ijeoma Opara and Tina Loarte-Rodriguez and Mitsuaki Sawano and Kekoa Taparra and Taylor, {Herman A.} and Watson, {Karol E.} and Yancy, {Clyde W.} and Krumholz, {Harlan M.}",

note = "Publisher Copyright: {\textcopyright} 2024 Faust JS et al. JAMA Network Open.",

year = "2024",

month = oct,

day = "11",

doi = "10.1001/jamanetworkopen.2024.38918",

language = "English (US)",

volume = "7",

pages = "e2438918",

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Faust, JS, Renton, B, Bongiovanni, T, Chen, AJ, Sheares, KD, Du, C, Essien, UR, Fuentes-Afflick, E, Haywood, T, Khera, R, King, T, Li, SX, Lin, Z, Lu, Y, Marshall, ADA, Ndumele, CD, Opara, I, Loarte-Rodriguez, T, Sawano, M, Taparra, K, Taylor, HA, Watson, KE, Yancy, CW & Krumholz, HM 2024, 'Racial and Ethnic Disparities in Age-Specific All-Cause Mortality during the COVID-19 Pandemic', JAMA network open, vol. 7, no. 10, pp. e2438918. https://doi.org/10.1001/jamanetworkopen.2024.38918

TY - JOUR

T1 - Racial and Ethnic Disparities in Age-Specific All-Cause Mortality during the COVID-19 Pandemic

AU - Faust, Jeremy Samuel

AU - Renton, Benjamin

AU - Bongiovanni, Tasce

AU - Chen, Alexander Junxiang

AU - Sheares, Karen Dorsey

AU - Du, Chengan

AU - Essien, Utibe R.

AU - Fuentes-Afflick, Elena

AU - Haywood, Trent

AU - Khera, Rohan

AU - King, Terris

AU - Li, Shu Xia

AU - Lin, Zhenqiu

AU - Lu, Yuan

AU - Marshall, Andrew D.A.

AU - Ndumele, Chima D.

AU - Opara, Ijeoma

AU - Loarte-Rodriguez, Tina

AU - Sawano, Mitsuaki

AU - Taparra, Kekoa

AU - Taylor, Herman A.

AU - Watson, Karol E.

AU - Yancy, Clyde W.

AU - Krumholz, Harlan M.

PY - 2024/10/11

Y1 - 2024/10/11

N2 - Importance: 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. Objectives: 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. Design, Setting, and Participants: 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. Exposures: COVID-19 PHE period (March 2020 to May 2023). Main Outcomes and Measures: All-cause excess mortality (incident rates, observed-To-expected ratios) and all-cause mortality relative risks before and during the PHE. Results: For the COVID-19 PHE period, data for 10643433 death certificates were available; mean (SD) decedent age was 72.7 (17.9) years; 944318 (8.9%) were Hispanic; 78973 (0.7%) were non-Hispanic American Indian or Alaska Native; 288680 (2.7%) were non-Hispanic Asian, 1374228 (12.9%) were non-Hispanic Black or African American, 52905 (0.5%) were non-Hispanic more than 1 race, 15135 (0.1%) were non-Hispanic Native Hawaiian or Other Pacific Islander, and 7877996 (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 252000 (18.3%) fewer excess deaths and more than 5.2 million (22.3%) fewer YPLL would have occurred. Conclusions and Relevance: In this cross-sectional study of the US population during the COVID-19 PHE, excess mortality occurred in all racial and ethnic groups, with disparities affecting several minoritized populations. The greatest relative increases occurred in populations aged 25 to 64 years. Documented differences deviated from prepandemic disparities.

AB - Importance: 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. Objectives: 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. Design, Setting, and Participants: 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. Exposures: COVID-19 PHE period (March 2020 to May 2023). Main Outcomes and Measures: All-cause excess mortality (incident rates, observed-To-expected ratios) and all-cause mortality relative risks before and during the PHE. Results: For the COVID-19 PHE period, data for 10643433 death certificates were available; mean (SD) decedent age was 72.7 (17.9) years; 944318 (8.9%) were Hispanic; 78973 (0.7%) were non-Hispanic American Indian or Alaska Native; 288680 (2.7%) were non-Hispanic Asian, 1374228 (12.9%) were non-Hispanic Black or African American, 52905 (0.5%) were non-Hispanic more than 1 race, 15135 (0.1%) were non-Hispanic Native Hawaiian or Other Pacific Islander, and 7877996 (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 252000 (18.3%) fewer excess deaths and more than 5.2 million (22.3%) fewer YPLL would have occurred. Conclusions and Relevance: In this cross-sectional study of the US population during the COVID-19 PHE, excess mortality occurred in all racial and ethnic groups, with disparities affecting several minoritized populations. The greatest relative increases occurred in populations aged 25 to 64 years. Documented differences deviated from prepandemic disparities.

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DO - 10.1001/jamanetworkopen.2024.38918

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SN - 2574-3805

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SP - e2438918

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JF - JAMA network open

IS - 10

ER -

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

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