Racial and Ethnic Disparities in Excess Deaths Among Persons With Kidney Failure During the COVID-19 Pandemic, March-July 2020

Kim, Daeho; Lee, Yoojin; Thorsness, Rebecca; Nguyen, Kevin; Swaminathan, Shailender; Rivera‐Hernandez, Maricruz; Trivedi, Amal N.

doi:10.1053/j.ajkd.2021.02.003

Cited by 18 publications

(16 citation statements)

References 7 publications

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“…A combination of these health and socioeconomic factors may have resulted in increased vulnerability of Black populations relative to White populations early in the pandemic, contributing to the observed time trends. Prior evidence from persons with kidney failure is consistent with this theory: amongst this at-risk population, Black mortality exceeded White mortality by the largest margin early on in the pandemic (Kim et al, 2021). This mechanism would also be consistent with the relationship between the Black/White mortality ratio and changes in COVID-19 prevalence.…”

Section: Discussionsupporting

confidence: 66%

Understanding Convergence Between Non-Hispanic Black and White COVID-19 Mortality: A County-Level Approach

Lawton

Zheng

et al. 2021

Preprint

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Background: Non Hispanic Black populations have suffered greater per capita COVID19 mortality at more than 1.5 times that of White populations. Previous work has established that, over time, rates of Black and White mortality have converged; however, some studies suggest that regional shifts in COVID19 prevalence may play a role in the relative change between racial groups. The study objective was to investigate changes in Black and White COVID19 mortality over time and uncover potential mechanisms driving these changes. Methods and Findings: Using county level COVID-19 mortality data stratified by race, we investigate the trajectory of non Hispanic Black mortality, White mortality, and the Black/White per capita mortality ratio from June 2020 to January 2021. Over this period, in the counties studied, cumulative mortality rose by 56.7% and 82.8% for Black and White populations respectively, resulting in a decrease in mortality ratio of 0.369 (23.8%). These trends persisted even when a county-level fixed-effects model was used to estimate changes over time within counties (controlling for all time invariant county level characteristics and removing the effects of changes in regional distribution of COVID19). Next, we leverage county level variation over time in COVID19 prevalence to show that the declines in the Black/White mortality ratio can be explained by changes in COVID19 prevalence. Finally, we study heterogeneity in the time trend, finding that convergence occurs most significantly in younger populations, areas with less dense populations, and outside of the Northeast. Limitations include suppressed data in counties with fewer than 10 deaths in a racial category, and the use of provisional COVID19 death data that may be incomplete. Conclusions: The results of this study suggest that convergence in Black/White mortality is not driven by county level characteristics or changes in the regional dispersion of COVID19, but instead by changes within counties. Further, declines in the Black/White mortality ratio appear strongly linked to changes in COVID19 prevalence, rather than a time specific effect. Further studies on changes in exposure by race over time, or on the vulnerability of individuals who died at different points in the pandemic, may provide crucial insight on mechanisms and strategies to further reduce COVID19 mortality disparities.

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Section: Discussionsupporting

confidence: 66%

Understanding Convergence Between Non-Hispanic Black and White COVID-19 Mortality: A County-Level Approach

Lawton

Zheng

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…A combination of these health and socioeconomic factors may have resulted in increased vulnerability of Black populations relative to White populations early in the pandemic, contributing to the observed time trends. Prior evidence from persons with kidney failure is consistent with this theory: amongst this at-risk population, Black mortality exceeded White mortality by the largest margin early on in the pandemic [32] . This mechanism would also be consistent with a prevalence-disparity relationship.…”

Section: Discussionmentioning

confidence: 67%

A longitudinal study of convergence between Black and White COVID-19 mortality: A county fixed effects approach

Lawton

Zheng

et al. 2021

The Lancet Regional Health - Americas

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Background Non-Hispanic Black populations have suffered much greater per capita COVID-19 mortality than White populations. Previous work has shown that rates of Black and White mortality have converged over time. Understanding of COVID-19 disparities over time is complicated by geographic changes in prevalence, and some prior research has claimed that regional shifts in COVID-19 prevalence may explain the convergence. Methods Using county-level COVID-19 mortality data stratified by race, we investigate the trajectory of Black and White per capita mortality from June 2020–January 2021. We use a county fixed-effects model to estimate changes within counties, then extend our models to leverage county-level variation in prevalence to study the effects of prevalence versus time trajectories in mortality disparities. Findings Over this period, cumulative mortality rose by 61% and 90% for Black and White populations respectively, decreasing the mortality ratio by 0.4 (25.8%). These trends persisted when a county-level fixed-effects model was applied. Results revealed that county-level changes in prevalence nearly fully explain changes in mortality disparities over time. Interpretation Results suggest mechanisms underpinning convergence in Black/White mortality are not driven by fixed county-level characteristics or changes in the regional dispersion of COVID-19, but instead by changes within counties. Further, declines in the Black/White mortality ratio over time appear primarily linked to county-level changes in COVID-19 prevalence rather than other county-level factors that may vary with time. Research into COVID-19 disparities should focus on mechanisms that operate within-counties and are consistent with a prevalence-disparity relationship. Funding This work was supported by the National Center for Advancing Translational Sciences [E.H.: UL1TR002553].

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“… 61 Another found that mortality among Hispanic patients with ESKD was 4-fold that of non-Hispanic patients. 62 A study by Hsu et al 63 based on patients from a midsize dialysis organization reported that male sex, Black race, treatment at an urban clinic, residence in a nursing home, and greater comorbidity burden were associated with COVID-19. Our results support these studies from the perspective of a national and more diverse chronic dialysis population.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis

et al. 2021

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Key Points Question What are the characteristics and mortality outcomes associated with COVID-19 among Medicare patients undergoing long-term dialysis? Findings This cohort study among 498 169 patients receiving regular maintenance dialysis found several risk factors for COVID-19 that persisted as risk factors for mortality: nursing home status, time on dialysis, congestive heart failure, diabetes, and comorbidity burden. Higher COVID-19 rates were observed among Black patients, while attenuated survival differences were observed between Black and non-Black patients, and although male sex was not associated with a higher COVID-19 rate, it was associated with higher mortality among patients with COVID-19. Meaning These findings suggest that among patients undergoing long-term dialysis, Black race, male sex, nursing home status, and having comorbidities, such as diabetes and cardiac diseases, were associated with higher risk of COVID-19 and higher post–COVID-19 mortality.

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Racial and Ethnic Disparities in Excess Deaths Among Persons With Kidney Failure During the COVID-19 Pandemic, March-July 2020

Cited by 18 publications

References 7 publications

Understanding Convergence Between Non-Hispanic Black and White COVID-19 Mortality: A County-Level Approach

Understanding Convergence Between Non-Hispanic Black and White COVID-19 Mortality: A County-Level Approach

A longitudinal study of convergence between Black and White COVID-19 mortality: A county fixed effects approach

COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis

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