Q&A: Racial disparities in excess deaths during pandemic widen life expectancy gap
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Black, American Indian/Alaska Native and Latino individuals had more than double the rate of excess deaths than white and Asian individuals in 2020, according to findings published in Annals of Internal Medicine.
“We observed profound racial and ethnic disparities in U.S. excess death rates in 2020 during the COVID-19 pandemic,” Meredith Shiels, PhD, MHS, an epidemiologist at the U.S. National Cancer Institute, and colleagues wrote.
Shiels and colleagues culled provisional death certificate data from the CDC and U.S. Census Bureau to assess excess deaths from March 2020 to December 2020. During this time period, 2.88 million deaths occurred, according to the researchers. They estimated that 477,200 were excess deaths, compared with 2019 data, and attributed 74% to COVID-19.
Age-standardized excess deaths per 100,000 people were two to three times higher among Black, American Indian/Alaska Native and Latino individuals than white and Asian individuals, according to Shiels and colleagues. Moreover, excess deaths per 100,000 people that were not related to COVID-19 were three to four times higher among Black and American Indian/Alaska Native individuals and nearly two times higher among Latino individuals compared with white individuals.
“These findings are consistent with a recent report that estimated that the life expectancy gap between Black persons and others has widened and the life expectancy advantage among Latino persons has shrunk,” Shiels and colleagues wrote. “The steady progress over the past 20 years in decreasing the mortality gap between Black and white persons has been rapidly eliminated by the COVID-19 pandemic and is likely to worsen as the full effect of the pandemic becomes apparent.”
Healio Primary Care spoke with Shiels and coauthor Anna Nápoles, PhD, MPH, the scientific director of the National Institute on Minority Health and Health Disparities (NIMHD), to learn more about disparities in excess deaths during the COVID-19 pandemic.
Healio Primary Care: What is the take-home message of your study?
Shiels: In the U.S., the COVID-19 pandemic has resulted in profound racial and ethnic disparities. Our study examined excess deaths in the first 10 months of the pandemic, March 2020 to December 2020. Though racial and ethnic disparities in COVID-19 deaths are striking, focusing on COVID-19 deaths alone without examining total excess deaths may underestimate the true impact of the pandemic. Excess death estimates capture deaths both directly and indirectly caused by COVID-19.
After adjusting for age and population size, we observed that excess deaths among Black, American Indian/Alaska Native and Latino males and females were more than double those in white and Asian males and females. The disproportionate impact of excess deaths in these groups resulted in rapid increases in racial and ethnic disparities in all-cause mortality between 2019 and 2020.
Healio Primary Care: Excess deaths were found both directly and indirectly caused by COVID-19. What is the significance of this for individuals of a racial/ethnic minority group?
Nápoles: COVID-19 doesn’t discriminate, but racial and ethnic minority groups are at a higher risk. Many long-standing factors contribute to higher rates of COVID-19 deaths among communities of color. These include structural inequities such as inadequate access to health care services, discrimination within the health care system, occupations that don’t always allow for social distancing or time off when ill, and multi-generational dwellings which can increase spread within households or buildings. Structural inequities also contribute to the disproportionate burden of compounding health conditions such as heart disease, diabetes, obesity and asthma.
Our efforts to increase vaccination rates and improve access to accurate and trusted information about COVID-19 must continue. These efforts must center on engaging with the communities hardest hit by the pandemic and making services accessible and practical. It requires us to be patient and listen to their concerns. Large scale efforts to end the structural inequities that drive these health disparities are a priority.
Healio Primary Care: Several studies have found disparities in how the pandemic has impacted different populations but what are people actually doing to mitigate this?
Nápoles: Here at NIMHD, and NIH more broadly, we have been focusing a lot on research. For example, we recently awarded five research grants to address COVID-19 vaccine hesitancy, uptake and implementation among populations who experience health disparities. Research is needed to understand and address misinformation, distrust and hesitancy in populations at increased risk for morbidity and mortality.
We also established two programs: RADx-UP to promote testing and interventions in the underserved and vulnerable communities and the Community Engaged Alliance (CEAL) against COVID-19 Disparities initiative which was initially established to increase and enhance participation in clinical trials. Today, CEAL, co-led by NIMHD and the National Heart, Lung and Blood Institute, has research teams established in 21 states across the U.S. They have partnered with organizations and reached communities of color to counter misinformation and mistrust about COVID-19, clinical trials and vaccines.
Healio Primary Care: What factors drive racial and ethnic disparities in excess deaths?
Shiels: Other research has established profound differences in mortality rates by race and ethnicity. The excess death estimates we report are in excess of the well-known disparities in premature mortality by race or ethnicity (premature death is defined as death before age 65) in the absence of COVID-19. As noted above, not all of the excess deaths were attributed to COVID-19.
Within the context of COVID-19, other researchers have shown that racial and ethnic disparities in COVID-19 risk, hospitalization and death can be attributed to structural and social determinants of health with established and deep roots in racism. Some of the reasons they cite include Black and Latino persons are more likely to have occupational exposure to COVID-19 than white persons. They also are more likely to live in multigenerational households and more densely populated neighborhoods and have less access to health care and private transportation. American Indian/Alaska Native reservation-based communities are at further risk for infection due to a lack of infrastructure and chronically underfunded health care facilities.
Healio Primary Care: How can these excess deaths be avoided/prepared for ahead of another health crisis?
Nápoles: There is an urgent need to address underlying structural inequities that have existed for a very long time and have contributed to the disproportionate impact of the pandemic on American Indian/Alaska Native, Black, Pacific Islander and Latino communities. Key actions such as improving access to health care and social services, ramping up community-based programs that address social determinants of health, and strengthening data collection, reporting and analysis can significantly improve our preparedness for future public health threats.
Shiels: These findings warn us that there is likely to be a severe widening of racial and ethnic disparities in all-cause mortality as longer-term data are released. Equitable vaccine distribution is needed to prevent further exacerbation of racial and ethnic disparities in COVID-19 risk and mortality. Inequities need to be addressed with urgency and cultural competence, as has been done by tribal communities in vaccinating a large fraction of their population. The disproportionate effect of the pandemic on Black, American Indian/Alaska Native and Latino communities has been devastating and highlights the urgent need to address long-standing structural inequities.
Reference:
Shiels MS, et al. Ann Intern Med. 2021;doi:10.7326/M21-2134.