The COVID Excess Mortality Percentage and Racial/Ethnic Disparities in COVID Mortality: Evidence from Indiana and Wisconsin

28 Pages Posted: 2 Nov 2022

See all articles by Vladimir A. Atanasov

Vladimir A. Atanasov

William and Mary - Raymond A. Mason School of Business

Paula Natalia Barreto Parra

Northwestern University

Lorenzo Franchi

Northwestern University

Jeff Whittle

Clement J. Zablocki Medical Center - Department of Medicine

John Meurer

Medical College of Wisconsin

Eric Luo

Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University

Andy Yuan

Northwestern University - Pritzker School of Law

Ruohao Zhang

Centre College

Bernard S. Black

Northwestern University - Pritzker School of Law

Date Written: October 10, 2022

Abstract

Importance: COVID-19 mortality rates increase with age, are higher among men than women, and vary across racial/ethnic groups, but this is also true for other natural causes of death. We develop a new measure of COVID-19 mortality burden, the COVID Excess Mortality Percentage (CEMP), defined as COVID-19 deaths as a fraction of all deaths from natural causes other than COVID-19. This measure can control for the effects of underlying population characteristics, including general population health, age, gender, race/ethnicity, and zip-code-level socioeconomic status (zip-SES) in predicting the COVID-19 mortality burden.

Objective: We use CEMP to study how COVID-19 mortality varies by age, gender, race/ethnicity, and zip-SES and between the pre-vaccine and vaccine-available periods.

Design. Retrospective analysis of all deaths from natural causes.

Setting: Indiana and Wisconsin.

Participants: All adult decedents from natural causes over the pandemic period from April 2020-March 2022.

Exposure: Demographic factors and vaccine availability.

Main Outcome and Measures: We report CEMP within sub-populations defined by age, gender, and race/ethnicity during the pre-vaccine (April 2020-March 2021) and vaccine-available (April 2021-March 2022) periods, and odds ratios from multivariable logistic regression.

Results: CEMP is broadly similar for men and women and rises gradually with age during the pre-vaccine period, but peaks at age 40-49 during the vaccine-available period. Racial/ethnic disparities can be very high, especially for Hispanics in the pre-vaccine period, with CEMP ratios for Hispanics to non-Hispanic Whites as high as 9:1 for men aged 50-59, and higher for men than for women. CEMP disparities were smaller but substantial for other minorities and declined with age after 60+. Differences in zip-SES and education explain only a small part of these disparities. National results for 2020 are consistent with our Indiana-Wisconsin findings.

Conclusions and Relevance: We studied COVID-19 mortality using a new measure that controls for non-COVID natural mortality rates. This approach is important in understanding racial/ethnic disparities in COVID-19 mortality. Disparities have been observed before, but not the very high Hispanic/White ratios we find for younger and middle-aged persons, especially men. Explanations for these disparities must account for age, gender, and time variation.

The Online Appendix is available at: http://ssrn.com/abstract=4244054

Note:
Funding Information: Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001436. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Conflict of Interests: The authors have no competing interests

Ethical Approval: The project was approved by the Medical College of Wisconsin Human Research Review Board.

Keywords: COVID-19; COVID-19 Mortality rate; Racial / Ethnic Disparities; COVID Excess Mortality Percentage

Suggested Citation

Atanasov, Vladimir A. and Barreto Parra, Paula Natalia and Franchi, Lorenzo and Whittle, Jeffrey and Meurer, John and Luo, Qian and Yuan, Andy and Zhang, Ruohao and Black, Bernard S., The COVID Excess Mortality Percentage and Racial/Ethnic Disparities in COVID Mortality: Evidence from Indiana and Wisconsin (October 10, 2022). Northwestern Law & Econ Research Paper No. 22-16, Available at SSRN: https://ssrn.com/abstract=4244039 or http://dx.doi.org/10.2139/ssrn.4244039

Vladimir A. Atanasov

William and Mary - Raymond A. Mason School of Business ( email )

P.O. Box 8795
Williamsburg, VA 23187-8795
United States

Paula Natalia Barreto Parra

Northwestern University ( email )

2001 Sheridan Road
Evanston, IL 60208
United States

Lorenzo Franchi

Northwestern University ( email )

2001 Sheridan Road
Evanston, IL 60208
United States

Jeffrey Whittle

Clement J. Zablocki Medical Center - Department of Medicine ( email )

5000 W. National Ave.
Milwaukee, WI 53295
United States

HOME PAGE: http://www.mcw.edu/display/router.asp?DocID=10377

John Meurer

Medical College of Wisconsin ( email )

United States
4145100375 (Phone)

HOME PAGE: http://https://www.mcw.edu/departments/institute-for-health-and-equity/people/john-meurer-md-mba

Qian Luo

Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University ( email )

2175 K St NW
Washington, DC 20052
United States

Andy Yuan (Contact Author)

Northwestern University - Pritzker School of Law ( email )

375 E. Chicago Ave
Chicago, IL 60611
United States

Ruohao Zhang

Centre College ( email )

600 West Walnut Street
Danville, KY 40422
United States

Bernard S. Black

Northwestern University - Pritzker School of Law ( email )

375 E. Chicago Ave
Chicago, IL 60611
United States
312-503-2784 (Phone)

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