Racial/Ethnic and Age Differences in the Direct and Indirect Effects of the COVID-19 Pandemic on US Mortality

Citation

Zalla, Lauren C.; Mulholland, Grace; Filiatreau, Lindsey M.; & Edwards, Jessie K. (2022). Racial/Ethnic and Age Differences in the Direct and Indirect Effects of the COVID-19 Pandemic on US Mortality. American Journal of Public Health, 112(1), 154-164. PMCID: PMC8713607

Abstract

Objectives. To estimate the direct and indirect effects of the COVID-19 pandemic on overall, race/ethnicity‒specific, and age-specific mortality in 2020 in the United States.
Methods. Using surveillance data, we modeled expected mortality, compared it to observed mortality, and estimated the share of "excess" mortality that was indirectly attributable to the pandemic versus directly attributed to COVID-19. We present absolute risks and proportions of total pandemic-related mortality, stratified by race/ethnicity and age.
Results. We observed 16.6 excess deaths per 10 000 US population in 2020; 84% were directly attributed to COVID-19. The indirect effects of the pandemic accounted for 16% of excess mortality, with proportions as low as 0% among adults aged 85 years and older and more than 60% among those aged 15 to 44 years. Indirect causes accounted for a higher proportion of excess mortality among racially minoritized groups (e.g., 32% among Black Americans and 23% among Native Americans) compared with White Americans (11%).
Conclusions. The effects of the COVID-19 pandemic on mortality and health disparities are underestimated when only deaths directly attributed to COVID-19 are considered. An equitable public health response to the pandemic should also consider its indirect effects on mortality.

URL

http://dx.doi.org/10.2105/AJPH.2021.306541

Reference Type

Journal Article

Year Published

2022

Journal Title

American Journal of Public Health

Author(s)

Zalla, Lauren C.
Mulholland, Grace
Filiatreau, Lindsey M.
Edwards, Jessie K.

Article Type

Regular

PMCID

PMC8713607

Data Set/Study

National Center for Health Statistics (NCHS)

Continent/Country

United States of America

State

Nonspecific

ORCiD

Filiatreau - 0000-0002-0355-4477
Edwards, J -0000-0002-1741-335X