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Cited by 146COVID-19 epidemiological studiesCOVID-19 Clinical Research StudiesHealth disparities and outcomes

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Disparities in excess mortality associated with COVID-19 - united states, 2020

Open access
Rossen, Lauren M., Ahmad, Farida B., Anderson, Robert N., Branum, Amy M., Du, Chengan, Krumholz, Harlan M., Li, Shu-Xia, Lin, Zhenqiu, Marshall, Andrew, Sutton, Paul D., Faust, Jeremy S.·2021·MMWR Morbidity and Mortality Weekly Report
DOI 10.15585/mmwr.mm7033a2PMC PMC8375709
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Abstract

The COVID-19 pandemic has disproportionately affected Hispanic or Latino, non-Hispanic Black (Black), non-Hispanic American Indian or Alaska Native (AI/AN), and non-Hispanic Native Hawaiian or Other Pacific Islander (NH/PI) populations in the United States. These populations have experienced higher rates of infection and mortality compared with the non-Hispanic White (White) population (1-5) and greater excess mortality (i.e., the percentage increase in the number of persons who have died relative to the expected number of deaths for a given place and time) (6). A limitation of existing research on excess mortality among racial/ethnic minority groups has been the lack of adjustment for age and population change over time. This study assessed excess mortality incidence rates (IRs) (e.g., the number of excess deaths per 100,000 person-years) in the United States during December 29, 2019-January 2, 2021, by race/ethnicity and age group using data from the National Vital Statistics System. Among all assessed racial/ethnic groups (non-Hispanic Asian [Asian], AI/AN, Black, Hispanic, NH/PI, and White populations), excess mortality IRs were higher among persons aged ≥65 years (426.4 to 1033.5 excess deaths per 100,000 person-years) than among those aged 25-64 years (30.2 to 221.1) and those aged <25 years (-2.9 to 14.1). Among persons aged <65 years, Black and AI/AN populations had the highest excess mortality IRs. Among adults aged ≥65 years, Black and Hispanic persons experienced the highest excess mortality IRs of >1,000 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.

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FIGURE 1 Weekly percentage excess all-cause mortality* for persons aged <25 years (A), 25–64 years (B), and ≥65 years (C), by race/ethnicity† — United States, 2020 Abbreviations: AI/AN = American Indian/Alaska Native; NH/PI = Native Hawaiian/Other Pacific Islander; sARIMA = seasonal autoregressive integrated moving average. * Weekly numbers of deaths from all causes by age group and race/ethnicity were obtained from the National Vital Statistics System. The expected numbers of deaths were estimated using sARIMA models of weekly all-cause mortality incidence rates (deaths per 100,000 population-weeks) from 2015–2019, multiplied by the weekly population projections during December 29, 2019–January 2, 2021. The percentage excess corresponds to the number of excess deaths divided by the expected number of deaths. Weeks 1–53 of 2020 are shown. The scale of the y-axis differs for each age group. † AI/AN, Asian, Black, NH/PI, and White persons were non-Hispanic; Hispanic persons could be of any race.
FIGURE 1 Weekly percentage excess all-cause mortality* for persons aged <25 years (A), 25–64 years (B), and ≥65 years (C), by race/ethnicity† — United States, 2020 Abbreviations: AI/AN = American Indian/Alaska Native; NH/PI = Native Hawaiian/Other Pacific Islander; sARIMA = seasonal autoregressive integrated moving average. * Weekly numbers of deaths from all causes by age group and race/ethnicity were obtained from the National Vital Statistics System. The expected numbers of deaths were estimated using sARIMA models of weekly all-cause mortality incidence rates (deaths per 100,000 population-weeks) from 2015–2019, multiplied by the weekly population projections during December 29, 2019–January 2, 2021. The percentage excess corresponds to the number of excess deaths divided by the expected number of deaths. Weeks 1–53 of 2020 are shown. The scale of the y-axis differs for each age group. † AI/AN, Asian, Black, NH/PI, and White persons were non-Hispanic; Hispanic persons could be of any race.CC0 · PubMed Central
FIGURE 2 Quarterly excess all-cause mortality incidence rates* and annual excess incidence rates† for persons aged <25 years (A), 25–64 years (B), and ≥65 years (C), by race/ethnicity§ — United States, 2020¶** Abbreviations: AI/AN = American Indian/Alaska Native; IR = incidence rates; NH/PI = Native Hawaiian/Other Pacific Islander. * Excess deaths per 100,000 person-quarters. † Annual excess death IRs for Hispanic, AI/AN, Asian, Black, NH/PI, and White persons were as follows: aged <25 years: 3.3, 6.5, −2.9, 14.1, −1.0, and 2.2, respectively; aged 25–64 years: 98.5, 221.1, 30.2, 133.4, 124.9, and 51.2, respectively; aged ≥65 years: 1,007.0, 650.0, 483.7, 1,033.5, 426.4, and 500.1, respectively. § AI/AN, Asian, Black, NH/PI, and White persons were non-Hispanic; Hispanic persons could be of any race. ¶ Weeks 1–52 (week 53 omitted to ensure each quarter consisted of 13 weeks and the four quarters summed to the total). The scale of the y-axis differs for each age group. ** Negative excess mortality IRs mean that there were fewer deaths than expected for that group.
FIGURE 2 Quarterly excess all-cause mortality incidence rates* and annual excess incidence rates† for persons aged <25 years (A), 25–64 years (B), and ≥65 years (C), by race/ethnicity§ — United States, 2020¶** Abbreviations: AI/AN = American Indian/Alaska Native; IR = incidence rates; NH/PI = Native Hawaiian/Other Pacific Islander. * Excess deaths per 100,000 person-quarters. † Annual excess death IRs for Hispanic, AI/AN, Asian, Black, NH/PI, and White persons were as follows: aged <25 years: 3.3, 6.5, −2.9, 14.1, −1.0, and 2.2, respectively; aged 25–64 years: 98.5, 221.1, 30.2, 133.4, 124.9, and 51.2, respectively; aged ≥65 years: 1,007.0, 650.0, 483.7, 1,033.5, 426.4, and 500.1, respectively. § AI/AN, Asian, Black, NH/PI, and White persons were non-Hispanic; Hispanic persons could be of any race. ¶ Weeks 1–52 (week 53 omitted to ensure each quarter consisted of 13 weeks and the four quarters summed to the total). The scale of the y-axis differs for each age group. ** Negative excess mortality IRs mean that there were fewer deaths than expected for that group.CC0 · PubMed Central

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Metadata

Authors
Rossen, L. M., Ahmad, F. B., Anderson, R. N., Branum, A. M., Du, C., Krumholz, H. M., Li, S.-X., Lin, Z., Marshall, A., Sutton, P. D., & Faust, J. S.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Rossen, Lauren M.
ORCID
Venue
MMWR Morbidity and Mortality Weekly Report
Publisher
Centers for Disease Control MMWR Office
Published
2021-08-20
Volume
70
Issue
33
Pages
1114-1119
ISSN
  • 0149-2195 (ISSN-L)
  • 1545-861X
DOI
10.15585/mmwr.mm7033a2
PMC
PMC8375709
OpenAlex
W3195344687
Cited by
146
References
10
Citations by year
2026: 9 · 2025: 7 · 2024: 27 · 2023: 41 · 2022: 51 · 2021: 11
FWCI
12.57
Type
journal article
Language
en
Open access
Locations
  • MMWR Morbidity and Mortality Weekly Report (publishedVersion)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (UL1TR001863)
  • National Center for Advancing Translational Sciences
Topics
  • Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Social Sciences › Health › Health disparities and outcomes
Keywords
COVID-19 pandemic, excess mortality, racial and ethnic disparities, Hispanic population, Black population, older adults, age-adjusted mortality rates, United States
MeSH terms
COVID-19, Adult, Aged, Ethnicity, Humans, Middle Aged, Mortality, United States, Age Distribution, Racial Groups, Health Status Disparities, Young Adult

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