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

21 Pages Posted: 17 Jan 2023 Last revised: 11 Jul 2023

See all articles by Andy Yuan

Andy Yuan

Northwestern University - Pritzker School of Law

Vladimir A. Atanasov

William and Mary - Raymond A. Mason School of Business

Paula Natalia Barreto Parra

Northwestern University

Lorenzo Franchi

Washington University in Saint Louis, John M. Olin Business School

Jeff Whittle

Clement J. Zablocki Medical Center - Department of Medicine

Benjamin Weston

Medical College of Wisconsin

John Meurer

Medical College of Wisconsin

Qian (Eric) Luo

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

Bernard S. Black

Northwestern University - Pritzker School of Law; European Corporate Governance Institute (ECGI)

Date Written: January 3, 2023

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

Suggested Citation

Yuan, Ye and Atanasov, Vladimir A. and Barreto Parra, Paula Natalia and Franchi, Lorenzo and Whittle, Jeffrey and Weston, Benjamin and Meurer, John and Luo, Qian and Black, Bernard S., Racial/Ethnic Disparities in COVID-19 Mortality: National Evidence from Death Certificates (January 3, 2023). Forthcoming at American Journal of Epidemiology; Northwestern Law & Econ Research Paper No. 23-01, Available at SSRN: https://ssrn.com/abstract=4317312 or http://dx.doi.org/10.2139/ssrn.4317312

Ye Yuan (Contact Author)

Northwestern University - Pritzker School of Law ( email )

375 E. Chicago Ave
Chicago, IL 60611
United States

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

Washington University in Saint Louis, John M. Olin Business School ( email )

Simon Hall 286, Olympian Way and Forsyth Blvd
St. Louis, MO 63130
United States

HOME PAGE: http://www.olin.wustl.edu

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

Benjamin Weston

Medical College of Wisconsin

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

Bernard S. Black

Northwestern University - Pritzker School of Law ( email )

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

European Corporate Governance Institute (ECGI)

Brussels
Belgium

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