COVID-19 Pandemic
Racial and ethnic disparities in excess deaths during the COVID-19 pandemic, March 2020 to December 2022 Anika T. Haque* Anika Haque Meredith S. Shiels Neal D. Freedman Amy Berrington de González
Background: The COVID-19 pandemic disproportionately impacted minoritized groups in the US. We estimated racial and ethnic disparities in excess deaths during COVID-19.
Methods: We obtained provisional death counts (2018-22) from death certificate data curated by the CDC; population estimates for the corresponding years were from the US Census Bureau. 2018-19 mortality rate data was used to generate expected death counts for 2020-22. Excess deaths were calculated by subtracting the expected deaths from the observed deaths from March 2020-December 2022. Rates were calculated by dividing excess deaths by the population count. Analyses were restricted to ≥35-year-olds, age-standardized to the 2019 population, stratified by race/ethnicity and year.
Results Compared to 2018-19 deaths, an estimated 462,300 excess deaths occurred between March and December 2020 (535,100 in 2021 and 306,900 in 2022). 75-76% of excess deaths were attributed to COVID-19 between 2020 and 2021, decreasing to 60% in 2022. Compared to White individuals (222.8 per 100,000), excess death rates between March 2020 and December 2022 were higher among Black (397.4), American Indian and Alaska Native (AI/AN) (467.5), Latino (347.8), and Native Hawaiian/Pacific Islander (NHPI) individuals (335.4); excess death rates for Asian Americans (151.7) were lower. Age-standardized non-COVID-19 excess deaths were 2-times higher in Black and AI/AN individuals than White individuals. Excess death disparities decreased over time; compared to White individuals, elevated excess death rates among Black (RRs=2.4, 1.8, 0.9 in 2020, 2021, and 2022, respectively) and Latino (RR=2.1, 1.7, and 0.7) individuals decreased in each subsequent year.
Conclusion: The COVID-19 pandemic had a substantial impact on US mortality, with excess deaths peaking in 2021. The findings highlight the disproportionate effect on Black, AI/AN, Latino, and NHPI communities. The racial and ethnic disparities in excess death rates declined over time.