Why are there such great disparities in COVID-19 deaths across race/ethnic groups in the U.S.? Here’s a recent review from New York City:
The racial/ethnic disparities in COVID-related mortality may be explained by increased risk of disease because of difficulty engaging in social distancing because of crowding and occupation, and increased disease severity because of reduced access to health care, delay in seeking care, or receipt of care in low-resourced settings. Another explanation may be the higher rates of hypertension, diabetes, obesity, and chronic kidney disease among Black and Hispanic populations, all of which worsen outcomes. The role of comorbidity in explaining racial/ethnic disparities in hospitalization and mortality has been investigated in only 1 study, which did not include Hispanic patients. Although poverty, low educational attainment, and residence in areas with high densities of Black and Hispanic populations are associated with higher hospitalizations and COVID-19–related deaths in NYC, the effect of neighborhood socioeconomic status on likelihood of hospitalization, severity of illness, and death is unknown. COVID-19–related outcomes in Asian patients have also been incompletely explored.
The analysis, interestingly, found that Black and Hispanic patients in New York City, once hospitalized, were less likely to die than White patients were. Lots of complicated issues here, but some combination of exposure through conditions of work, transportation, and residence; existing health conditions; and access to and quality of care. My question is more basic, though: What are the age-specific mortality rates by race/ethnicity?
Start tangent on why age-specific comparisons are important. In demography, breaking things down by age is a basic first-pass statistical control. Age isn’t inherently the most important variable, but (1) so many things are so strongly affected by age, (2) so many groups differ greatly in their age compositions, and (3) age is so straightforward to measure, that it’s often the most reasonable first cut when comparison groups. Very frequently we find that a simple comparison is reversed when age is controlled. Consider a classic example: mortality in a richer country (USA) versus a poorer country (Jordan). People in the USA live four years longer, on average, but Americans are more than twice as likely to die each year (9 per 1,000 versus 4 per 1000). The difference is age: 23% of Americans are over age 60, compared with 6% of Jordanians. More old people means more total deaths, but compare within age groups and Americans are less likely to die. A simple separation by age facilitates more meaningful comparison for most purposes. So that’s how I want to compare COVID-19 mortality across race/ethnic groups in the USA. End tangent.
Age-specific mortality rates
It seems like this should be easier, but I can’t find anyone who is publishing them on an ongoing basis. The Centers for Disease Control posts a weekly data file of COVID-19 deaths by age and race/ethnicity, but they do not include the population denominators that you need to calculate mortality rates. So, for example, it tells you that as of December 5 there have been 2,937 COVID-19 deaths among non-Hispanic Blacks in the age range 30-49, compared with 2,186 deaths among non-Hispanic Whites of the same age. So, a higher count of Black deaths. But it doesn’t tell you there are 4.3-times as many Whites as Blacks in that category. So a much higher mortality rate.
On a different page, they report the percentage of all deaths in each age range that have occurred in each race/ethnic group, don’t include their percentage in the population. So, for example, 36% of the people ages 30-39 who have died from COVID-19 were Hispanic, and 24% were non-Hispanic White, but that’s not enough information to calculate mortality rates either. I have no reason to think this is nefarious, but it’s clearly not adequate.
So I went to the 2019 American Community Survey (ACS) data distributed by IPUMS.org to get some denominators. These are a little messy for two main reasons. First, ACS is a survey that asks people what their race and ethnicity are, while death counts are based on death certificates, for which the person who has died is not available to ask. So some people will be identified with a different group when they die than they would if they were surveyed. Second, the ACS and other surveys allow people to specify multiple races (in addition to being Hispanic or not), whereas death certificate data generally does not. So if someone who identifies as Black-and-White on a survey dies, how will the death certificate read? (If you’re very interested, here’s a report on the accuracy of death certificates, and here are the “bridges” they use to try to mash up multiple-race and single-race categories.)
My solution to this is make denominators more or less the way race/ethnicity was defined before multiple race identification was allowed. I put all Hispanic people, regardless of race, into the Hispanic group. Then I put people who are White, non-Hispanic, and no other race into the White category. And then for the Black, Asian, and American Indian categories, I include people who were multiple race (and not Hispanic). So, for example, a Black-White non-Hispanic person is counted as Black. A Black-Asian non-Hispanic person is counted as both Black and Asian. Note I did also do the calculations for Native Hawaiian and Other Pacific Islanders, but those numbers are very small so I’m not showing them on the graph; they’re on the spreadsheet. Note also I say “American Indian” to include all those who are “non-Hispanic American Indian or Alaska Native.”
This is admittedly crude, but I suggest that you trust me that it’s probably OK. (Probably OK, that is, especially for Whites, Blacks, and Hispanics. American Indians and Asians have higher rates of multiple-race identification among the living, so I expect there would be more slippage there.)
Anyway, here’s the absolutely egregious result:
This figure allows race/ethnicity comparisons within the five age groups (under 30 isn’t shown). It reveals that the greatest age-specific disparities are actually at the younger ages. In the range 30-49, Blacks are 5.6-times more likely to die, and Hispanics are 6.6-times more likely to die, than non-Hispanic Whites are. In the oldest age group, over 85, where death rates for everyone are highest, the disparities are only 1.5- and 1.4-to-1 respectively.
Whatever the cause of these disparities, this is just the bottom line, which matters. Please note how very high these rates are at old ages. These are deaths per 100,000, which means that over age 85, 1.8% of all African Americans have died of COVID-19 this year (and 1.7% for Hispanics and 1.2% for Whites). That is — I keep trying to find words to convey the power of these numbers — one out of every 56 African Americans over age 85.
Please stay home if you can.
A spreadsheet file with the data, calculations, and figure, is here: https://osf.io/ewrms/.