COVID-19 and All-Cause Mortality by Race, Ethnicity, and Age Across Five Periods of the Pandemic in the United States

Abstract

Racial/ethnic and age disparities in COVID-19 and all-cause mortality during 2020 are well documented, but less is known about their evolution over time. We examine changes in age-specific mortality across five pandemic periods in the United States from March 2020 to December 2022 among four racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian) for ages 35+. We fit Gompertz models to all-cause and COVID-19 death rates by 5-year age groups and construct age-specific racial/ethnic mortality ratios across an Initial peak (Mar–Aug 2020), Winter peak (Nov 2020–Feb 2021), Delta peak (Aug–Oct 2021), Omicron peak (Nov 2021–Feb 2022), and Endemic period (Mar–Dec 2022). We then compare to all-cause patterns observed in 2019. The steep age gradients in COVID-19 mortality in the Initial and Winter peak shifted during the Delta peak, with substantial increases in mortality at working ages, before gradually returning to an older age pattern in the subsequent periods. We find a disproportionate COVID-19 mortality burden on racial and ethnic minority populations early in the pandemic, which led to an increase in all-cause mortality disparities and a temporary elimination of the Hispanic mortality advantage at certain age groups. Mortality disparities narrowed over time, with racial/ethnic all-cause inequalities during the Endemic period generally returning to pre-pandemic levels. Black and Hispanic populations, however, faced a younger age gradient in all-cause mortality in the Endemic period relative to 2019, with younger Hispanic and Black adults in a slightly disadvantageous position and older Black adults in a slightly advantageous position, relative to before the pandemic.

Cause-Specific Excess Mortality in the US During the COVID-19 Pandemic

“…Our age-stratified and compositionally robust modeling approach did not allow us to model causes not occurring at all ages, so we were unable to look at ADRD, which Chen, et al 22 identified as a source of non-COVID-19 excess in the first year of the pandemic. We did not disaggregate excess mortality by geography or race/ethnicity, which have been strongly associated with COVID-19 mortality 16,43 . Further examination of how cause-specific mortality differed by social factors could help illuminate both the direct and indirect pathways through which the pandemic impacted mortality.…”

Subnational contribution to life expectancy and life span variation changes: Evidence from the United States

“…Additionally, the overall burden on the health care system in the United States was substantial during COVID-19 (Montez et al 2020;Montez 2020). The persistent and disproportionate heavy impact of COVID-19 on the mortality of different minority race and ethnic groups, in comparison to non-Hispanic white Americans, also plays into the regional contribution at the local level Andrasfay and Goldman 2021;Luck et al 2023). Based on our findings, we also expect that during 2020-2021, if the trends observed in 2019-2020 continue, the southern region will make a more significant contribution to changes in life span variation compared to regions exhibiting similar age patterns.…”

Immigrant mortality advantage in the United States during the first year of the COVID-19 pandemic

“…Life expectancy at birth declined by 1.4 years for non-Hispanic White (henceforth White), by 3.3 years for non-Hispanic Black (henceforth Black), by 4.0 years for Hispanic, and by 2.0 years for non-Hispanic Asian (hereafter Asian) populations in 2020 compared to 2019, with somewhat larger declines for men than for women. These trends reversed much of the progress made by the Black population relative to the White population during the previous decades and almost eliminated the long-standing Hispanic mortality paradox -i.e., lower mortality among the Hispanic population relative to the White population despite their lower socioeconomic status (Andrasfay and Goldman 2021;Luck et al 2023a;Sáenz and Garcia 2021;Woolf et al 2021). Although much of the increase was driven by COVID-19 mortality, mortality also increased for circulatory diseases, Alzheimer's disease and other dementias, diabetes, and external causes (Luck et al 2022).…”