Underrepresented populations experienced higher rates of excess mortality in 2020

New data in MMWR showed that underrepresented populations had higher rates of excess mortality in 2020, and that COVID-19 was largely responsible for excess deaths among adults aged 25 years and older.

Lauren Rossen, PhD, a senior health statistician in the division of research and methodology at the National Center for Health Statistics, and colleagues analyzed data from the United States’ National Vital Statistics System and U.S. Census Bureau to determine the rate of excess deaths for each 100,000 person-years from Dec. 29, 2019, to Jan. 2, 2021, and the percentage of those deaths that were “directly attributed to COVID-19.”

Rossen and colleagues reported that among adults aged younger than 65 years, Black and American Indian or Alaska Native populations had the highest excess mortality incidence rates. Among those aged 65 years and older, Black and Hispanic populations had the highest excess mortality incidence rates of more than 1,000 extra deaths for each 100,000 person-years.

Specifically, among adults aged 65 years or older, there were 52,132 extra deaths among Hispanic people, of which 85% were linked to COVID-19; 2,215 extra deaths among American Indian or Alaska Native people, of which 123.8% were linked to COVID-19; 13,554 extra deaths among Asian people, of which 80.6% were linked to COVID-19; 55,004 extra deaths among Black people, of which 78.7% were linked to COVID-19; 304 extra deaths among Native Hawaiian or Pacific Islanders, of which 109.4% were linked to COVID-19; and 223,995 extra deaths among white people, of which 93.2% were linked to COVID-19. The researchers noted that values of 100% or more indicate that the number of COVID-19-related deaths exceeds the number of excess deaths.

Among adults aged 25 to 64 years, there were 32,305 extra deaths among Hispanic people, of which 77.7% were linked to COVID-19; 2,950 extra deaths among American Indian or Alaska Native people, of which 61.2% were linked to COVID-19; 3,613 extra deaths among Asian people, of which 76.8% were linked to COVID-19; 30,035 extra deaths among Black people, of which 57.1% were linked to COVID-19; 447 extra deaths among Native Hawaiian or Pacific Islanders, of which 79.2% were linked to COVID-19; and 54,197 extra deaths among white people, of which 46.4% were linked to COVID-19.

In addition, among those aged younger than 25 years, there were 857 extra deaths among Hispanic people, of which 33.7% were linked to COVID-19; 58 extra deaths among American Indian or Alaska Native people, of which 34.3% were linked to COVID-19; 1,983 extra deaths among Black people, 9.8% of which were linked to COVID-19; and 1,299 extra deaths among white people, 13.6% of which were linked to COVID-19.

“Of the nearly 2,000 excess deaths among Black persons aged younger than 25 years, more than 90% were not directly attributed to COVID-19. Given that injury-related causes of death are typically the leading causes of death among younger age groups, these excess deaths among younger groups and related disparities might be related to increases in homicide, drug overdose and unintentional injuries in 2020,” the researchers wrote.

Overall, across all racial and ethnic groups, excess mortality incidence rates were higher among people aged 65 years or older (426.4 to 1033.5 excess deaths per 100,000 person-years) than those aged 25 to 64 years (30.2 to 221.1 excess deaths per 100,000 person-years) and younger than 25 years (–2.9 to 14.1 excess deaths per 100,000 person-years).

“These findings could help guide more tailored public health messaging and mitigation efforts to reduce disparities in mortality associated with the COVID-19 pandemic in the United States, by identifying the racial/ethnic groups and age groups with the highest excess mortality rates,” Rossen and colleagues wrote.