COVID-19 Pandemic
Natural cause mortality inequities by immigration status among Asians and Pacific Islanders in California: March 2020 through February 2023 Ye Ji Kim* Ye Ji Kim Alicia R. Riley Josefina Flores Moraes Marie-Laure Charpignon Matthew V. Kiang Shelley DeVost Andrew C. Stokes Ruijia Chen Yea-Hung Chen Maria Glymour
Asian and Pacific Islanders (API) are the fastest growing population in the US. Yet, mortality inequities by subgroups remain unclear as this population is often treated as a monolith. Here, to inform future tailored pandemic responses, we quantify excess natural-cause mortality among API subgroups. We used individual-level death certificate data from the California Department of Public Health from Jan 2016 through Feb 2023. We restricted the analysis to California Asian residents (ages 25 and older) who died due to a natural cause to understand underlying health inequities. We classified decedents by age, country of birth, and immigration status (US-born citizens, documented foreign-born (FB), and undocumented FB persons based on their country of birth and no record of a plausible SSN sequence). The natural-cause excess deaths and relative risks were calculated for the time period Mar 2020 through Feb 2023, relative to the pre-pandemic period (Jan 2016 to Feb 2020), using dynamic harmonic regressions. The risk of natural-cause death among undocumented FB Asians almost doubled during the pandemic (RR (95% prediction interval)=1.9 (1.4, 3.1)), compared to a 20% increase among US-born Asian citizens (RR=1.2 (1.1, 1.3)) and documented FB Asians (RR=1.2 (1.1, 1.2)). Further, undocumented FB Asians who were more than 65 years old had nearly 3 times the risk of a natural cause death during than prior to the pandemic (RR=2.8 (1.8, 5.9)). In contrast, excess mortality was slightly higher among younger, US-born (RR=1.3(1.1, 1.6)) and documented FB Asians (RR=1.2 (1.2, 1.3)) than those over 65 (RR for US=1.2(1.1,1.2); RR for FB=1.1(1.0,1.5)). The COVID-19 pandemic had disparate impacts on natural-cause mortality among API populations, with especially harmful effects on undocumented FB individuals.