Today in JAMA Network Open, a Mass General Brigham-led research team reports that US all-cause excess mortality during the COVID-19 pandemic disproportionately affected several minoritized populations, with the largest relative increase in adults aged 25 to 64 years—which the authors said implies lasting downstream consequences.
The researchers characterized overall and age-specific excess mortality by race by analyzing all US all-cause deaths related to the COVID-19 public health emergency (March 2020 to May 2023). They also evaluated whether measured differences reflected changes from racial disparities before the pandemic.
Excess deaths number more than 1.38 million
More than 1.38 million all-cause excess deaths (observed-to-expected ratio, 1.15) occurred, corresponding to about 23 million years of potential life lost (YPLL) during the pandemic. Excess deaths included roughly 9,000 Black (542,000 YPLL), 6,000 Hispanic (395,000 YPLL), 400 American Indian or Alaska Native (AIAN; 24,000 YPLL), and 100 Native Hawaiian and other Pacific Islander people (7,500 YPLL).
The highest observed-to-expected mortality ratios occurred among AIAN (1.31) and Hispanic populations (1.31). But the ratios were highest in people aged 25 to 64 years (1.20), particularly AIANs (1.45), Hispanics (1.40), and Native Hawaiians or other Pacific Islanders (1.39) in this age-group.
The proportion of excess mortality exceeded the share of the population among AIAN, Black, and Native Hawaiian or other Pacific Islander populations. For example, among adults aged 25 years and older, Black people made up 51.1% of excess deaths, despite representing only 13.8% of the population.
Greater YPLL per-capita and per-excess deaths among AIAN, Black, Hispanic, and Native Hawaiian or other Pacific Islander populations were seen, reflecting their younger average and median ages of decedents compared with Asian and White people. More than 454,000 (32.9%) excess deaths occurred in people 0 to 64 years old, accounting for about 14.2 million (61.2%) of the overall YPLL.
Pandemic worsened historical mortality disparities
If the rate of excess mortality seen among White people had been observed among the total population, more than 252,000 (18.3%) fewer excess deaths and more than 5.2 million (22.3%) fewer YPLL would have occurred.
We demonstrate that the pandemic appears to have exacerbated historical mortality disparities that have long been understood to reflect strata in social determinants of health, structural inequality, and racism, and which have persisted.
While adults aged 65 years and older made up 67% of excess mortality in the US population, in the AIAN and Native Hawaiian or other Pacific Islander populations only, people younger than 65 accounted for most excess deaths (60.5% and 70.3%, respectively).
The magnitude of excess mortality both overall and within age-groups was greater before than after the development of COVID-19 vaccines. Established and largely stable pre-COVID disparities in all-cause death by race changed at the pandemic onset, with the studied racial groups at higher relative risk of death after March 2020.
By the third year of the pandemic, relative risks for death had returned to prepandemic levels except for AIANs and Native Hawaiians or other Pacific Islanders.
“Importantly, we demonstrate that the pandemic appears to have exacerbated historical mortality disparities that have long been understood to reflect strata in social determinants of health, structural inequality, and racism, and which have persisted,” the study authors wrote.
The racial disparities can’t be explained by genetics alone, the researchers said. “While pandemics are inevitable, disparities are not,” they wrote. “The need to address the conditions that create health disparities—before the next public health crisis—is evident.”
