COVID-19 mortality rates by race/ethnicity and age

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/.

Race and racism in America (video)

In my Social Problems class we’re spending the next few weeks on race, racial inequality, and racial politics. Step one is this lecture on race and racism.

After a tangent on racial identity, idealism and its enemies, I address biology and race, describing the classic racist racial categories in relation to vast human diversity in Africa and the world overall, with discussion of biological evolution and the sources of human variation. Then I turn to the US and discuss social definition and self-definition, race versus ethnicity, definitions of racism and discrimination, and how the Census Bureau measures US race and ethnicity, before summarizing current and projected race/ethnic composition. And I used the new Zoom feature where your PowerPoint slides are the virtual background (which is harder than it looks because your image isn’t mirrored while you speak!).

It’s 35 minutes. The slides are here, CC-BY: osf.io/uafvp. To see all my videos, visit my YouTube channel.

Black is not a color

When I saw this magazine cover, I did a double-take:

At a glance I didn’t think that was Black Hair. Seems like a good time to bring up the old schoolyard debate point: Black is not a color.

In many quarters, such as the those administered under the rules of the Chicago Manual of Style, black is a color, which means it’s not capitalized:

8.39 Color. Common designations of ethnic groups by color are usually lowercased unless a particular publisher or author prefers otherwise… (black people; blacks; people of color; white people; whites)

That rule, from the 16th edition, is progress from the 15th, which said “capitalization may be appropriate if the writer strongly prefers it” (8.43, emphasis added). Under that older provision in 1996, the journal Signs required that I add a footnote in my first journal publication, which read, “I … capitalize Black to signify its reference to a people rather than a color or a ‘race.'”*

Most media do not capitalize Black or White. The Associated Press Stylebook reads:

black Acceptable for a person of the black race. African-American is acceptable for an American black person of African descent. (Use Negro only in names of organizations or in quotations.) Do not use colored as a synonym.

So, for example:

Trayvon Martin was shot and killed by a crime watch volunteer in a gated community in Sanford, Fla., in February 2012. The death of the unarmed black teenager and the decision of the local police not to bring charges against the volunteer, George Zimmerman, 28, set off a national outcry…

Sociology journals are inconsistent. For example, the American Sociological Review goes both ways (e.g., this 2010 presidential address used uncapitalized black, while our 2007 article’s capitalization sailed through without objection). On the other hand, some sociology journals follow the more progressive APA Style, in which Black is capitalized (as is White).

In the wider American world – at least as measured by Google Books ngrams – the uncapitalized version is leading by about 3-to-1.

(Black by itself wouldn’t work, so I added “people.” The pattern is the same if you use “community” instead.)

The Census Bureau capitalizes, as in this report on the 2010 Census:

“Black or African American” refers to a person having origins in any of the Black racial groups of Africa. It includes people who indicated their race(s) as “Black, African Am., or Negro” or reported entries such as African American, Kenyan, Nigerian, or Haitian.

That usage differs from the Office of Management and Budget directive, from which that language is drawn: “…any of the black racial groups of Africa,” without capitalization. That Census practice of capitalizing seems to have started between 1990 and 1995. (Others, like the Department of Education, have their own rules, which specify that racial designations should be capitalized.)

Finally, African American is not going to get us out of this. It is not appropriate when the subject really is race rather than ethnicity. I feel for this poor research subject in a Census cognitive interview:

She is an immigrant to the US from Africa. However, roughly six generations ago her ancestors were from India. She lived in an Indian community in Africa prior to immigrating to the United States. She answered “no” to … “Black or African American” because she was from an African country, but of Indian origin. She answered “yes” to the Asian question and “yes” to Asian Indian. She also reported ‘some other race’ by saying “African, not African American, African from Africa, Asian African.”

Anyway, Black and White are racial terms. They are a social construction and not a biological classification. We use them socially. Whether or not that’s OK, I think it’s better to capitalize them at least.

*Update: I just noticed this footnote by Catharine MacKinnon, who was also asked by Signs (University of Chicago Press) to justify capitalizing Black for her 1982 articlewhich I assigned in my stratification seminar. She wrote:

I have rendered “marxism” in lower case and “Black” in upper case and have been asked by the publisher to explain these choices. … Black is conventionally (I am told) regarded as a color rather than a racial or national designation, hence is not usually capitalized. I do not regard Black as merely a color of skin pigmentation, but as a heritage, an experience, a cultural and personal identity, the meaning of which becomes specifically stigmatic and/or glorious and/or ordinary under specific social conditions. It is as much socially created as, and at least in the American context no less specifically meaningful or definitive than, any linguistic, tribal, or religious ethnicity, all of which are conventionally recognized by capitalization.

I guess I should have cited her note for my article.

P.S. If your organization or publication has its own way – or I’ve misrepresented a practice you know better than I do – please let us know.