key: cord-0895870-49wupeg3
authors: Rossen, Lauren M.; Gold, Jeremy A.W.; Ahmad, Farida B.; Sutton, Paul D.; Branum, Amy M.
title: Trends in the distribution of COVID-19 deaths by age and race/ethnicity — United States, April 4–December 26, 2020
date: 2021-06-20
journal: Ann Epidemiol
DOI: 10.1016/j.annepidem.2021.06.003
sha: a7ed519024740aaba08c7a6ff8addf1c43326a3f
doc_id: 895870
cord_uid: 49wupeg3

nan

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected racial and ethnic minority groups. [1] [2] [3] [4] [5] COVID-19 infection and mortality rates are higher among Hispanic/Latino, non-Hispanic Black, and non-Hispanic American Indian or Alaska Native (AI/AN) populations than non-Hispanic White populations. 5 Although most U.S. COVID-19 deaths have occurred among adults aged ≥65 years, younger persons represent a larger percentage of COVID-19 deaths in Hispanic/Latino, non-Hispanic Black, and non-Hispanic AI/AN populations. 1 These racial/ethnic groups also have younger age distributions across the population generally, 3 and face increased risk of COVID-19 infection and related morbidity and mortality as a result of many different factors such as the degree of occupational exposure, housing or residential risk factors, the prevalence of preexisting health conditions, reduced access to care, and structural racism. [1] [2] [3] [4] The proportion of deaths by age and race/ethnicity has changed over the course of the pandemic, with a recent report demonstrating growing percentages among the Hispanic population from May through August, 2020. 5 However, that report did not examine changes in the distribution of COVID-19 deaths by race/ethnicity across age groups (or vice versa) over the course of the pandemic in 2020. Moreover, it is unknown how patterns by age and race/ethnicity may have changed more recently, over the most recent wave of the pandemic occurring at the end of 2020. To examine this, we describe weekly trends in COVID-19 deaths by age and race/ethnicity from April through December 26, 2020.

Using data from the National Vital Statistics System on 363,087 U.S. COVID-19 deaths occurring from the weeks ending April 4-December 26, 2020, 6 COVID-19 deaths were identified based on the International Classification of Diseases, Tenth Revision code U07.1 appearing as a contributing or underlying cause of death on the death certificate. 6 Of these, more than 90% list COVID-19 as the underlying cause of death (90% among non-Hispanic white; 92% among non-Hispanic AI/AN, non-Hispanic Asian, non-Hispanic Black, and non-Hispanic other/unknown race; and 95% among Hispanic). 7 We calculated the percentage distribution of COVID-19 deaths by age group ( 

The largest percentage of COVID-19 deaths among the non-Hispanic White and Non-Hispanic Asian population were among those aged 85+ years, and those 75 and older accounted for more than half of COVID-19 deaths through the entire study period for these groups. However, for Hispanic/Latino, non-Hispanic Black, non-Hispanic AI/AN, and non-Hispanic NHOPI, more than half of COVID-19 deaths from April through December were among persons aged <75 years. The age distributions of COVID-19 deaths within each racial/ethnic group were fairly consistent over time. Within age groups, there was more variability over the study period in the distribution of COVID-19 deaths by race/ethnicity. Specifically, in recent months, the percentage of deaths among non-Hispanic White people has grown across all age groups. The percentage of deaths among non-Hispanic Black people has declined since April across all age groups 25 years and older. Additionally, since peaking in late July, the percentage of COVID-19 deaths among Hispanic people has declined across all age groups 25 years and older.

These findings may be impacted by differential testing and reporting of COVID-19 on death certificates by age and race/ethnicity, factors which may vary over time. Previous analyses of excess deaths due to COVID-19 have suggested that COVID-19 deaths are likely underestimated, and that certain racial/ethnic subgroups bear a disproportionately high burden of excess mortality. 8 Consequently, the disparities in COVID-19 deaths by race/ethnicity shown here may be even wider if there is differential underestimation among certain racial/ethnic groups. Finally, this analysis did not examine differential risk of COVID-19 mortality across population groups (i.e., death rates and relative or absolute differences). A recent report found that age-adjusted COVID-19 death rates in 2020 were highest among non-Hispanic AI/AN (187.8 deaths per 100,000), followed by Hispanic (164.3), non-Hispanic Black (151.1), Non-Hispanic NHOPI (122.3), non-Hispanic White (72.5), non-Hispanic Asian (66.7), and non-Hispanic Multiracial (31.8) populations. 9 Prior analyses have found that COVID-19 death rates increase with age within each racial/ethnic group, and that death rates are highest among those 85 years and older. 1

These findings show a consistently younger age distribution of COVID-19 deaths among certain racial/ethnic groups, which may inform targeted efforts to prevent mortality and reduce inequities.

Given that a majority of COVID-19 deaths among Hispanic/Latino, non-Hispanic Black, non-Hispanic AI/AN, and non-Hispanic NHOPI were among persons aged <75 years from April through December, disparities in COVID-19 mortality may worsen if prevention efforts are targeted based on older age alone. 10 Figure 1 . Weekly percent of COVID-19 deaths in each age group, by race/ethnicity (top); and percent in each racial/ethnic group, by age (bottom) -April 4-December 26, 2020.

NOTES: The weekly percentage distribution of COVID-19 deaths is shown using a 4-week rolling sum of COVID-19 deaths to mitigate the week-to-week variability in the percentages. Abbreviations: NHOPI

Variation in racial/ethnic disparities in COVID-19 mortality by age in the United States: A cross-sectional study

Sharpening the global focus on ethnicity and race in the time of COVID-19

Racial and Ethnic Disparities in Population-Level Covid-19 Mortality

COVID-19 and Racial/Ethnic Disparities

Ethnicity, and Age Trends in Persons Who Died from COVID-19 -United States

Death Data and Resources

AH Monthly Provisional Counts of Deaths for Select Causes of Death by Age, and Race and Hispanic Origin

Excess Deaths Associated with COVID-19, by Age and Race and Ethnicity -United States

Provisional Mortality Data -United States

Vaccine Distribution-Equity Left Behind? JAMA

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.