Racial/Ethnic Disparities in COVID-19 Mortality: National Evidence from Death Certificates

Abstract

While prior research documents racial/ethnic disparities in COVID-19 morbidity and mortality, it has often not considered to what extent these disparities reflect COVID-19 specific factors, versus preexisting health differences, which also affect COVID-19 risk. This study uses national, death-certificate-level data for 2020 to examine how racial/ethnic disparities in COVID-19 mortality vary with age, gender, and time period, using mortality from other natural causes to proxy for underlying health status. We study a novel measure, the COVID Excess Mortality Percentage (CEMP), defined as the COVID-19 mortality rate, divided by the non-COVID natural mortality rate (Non-Covid-NMR), converted to a percentage, where Non-Covid-NMR, is the CEMP denominator, controls, albeit imperfectly, for differences in population health. Disparities measured using the CEMP outcome deviate substantially from those described in prior research. In particular, relative to prior work, we find very high disparities (up to 12:1) in CEMP rates for Hispanics when compared to Whites, particularly for non-elderly men. Asians also have elevated CEMP rates relative to Whites, which were obscured in prior work due to lower overall Asian mortality. Native American, and Black populations have significant disparities when compared to White populations, but in contrast to Hispanics and Asians, CEMPS ratios to Whites are substantially lower than COVID-19 mortality rate ratios, or all-cause excess mortality ratios, reported in other work. This is because the higher COVID-19 mortality for Blacks and Native Americans comes partly from higher general mortality risk, and partly from COVID-specific risk.

The online appendix is available at http://ssrn.com/abstract=4317316

Note:
Funding declaration: This project was funded by the National Institutes of Health, award 3 UL1 TR001436-06S1, and was approved by the Medical College of Wisconsin Human Research Review Board.

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, mortality, racial/ethnic disparities