Death rates for working-age, young Black people rose during pandemic

The likelihood of death for Black people under the age of 25 and working-age adults increased significantly during the coronavirus pandemic, according to new research on mortality rates published Friday in the journal JAMA Network Open.

The study reviewed deaths across age, race and ethnicity and highlights how the pandemic disproportionately affected the nation’s core adult population alongside historically underserved racial and ethnic communities. It found that disparities in mortality were not simply replicated during the pandemic – they were exacerbated.

“When there’s a crisis, we need to mobilize our resources towards the groups who are most at risk because that means that every action you take will save that many more lives,” said Jeremy Faust, lead author on the paper and emergency physician at Brigham and Women’s Hospital in Boston.

The authors studied pre-pandemic data to calculate the number of deaths that would have taken place had the pandemic not occurred. They then examined data from over 10.6 million death certificates to determine how many people died during the U.S. coronavirus public health emergency, which was declared in March 2020 and expired in May 2023. The authors analyzed deaths due to a variety of causes, allowing them to capture deaths directly attributable to COVID-19. They also analyzed deaths that weren’t officially classified as COVID-related but were probably due to the virus and cases in which the pandemic exacerbated existing health conditions.

By subtracting projected deaths from actual deaths, the authors calculated a quantity called excess deaths – a commonly studied metric in emergencies, such as pandemics and natural disasters, when more deaths than usual are expected to occur. The researchers found that nearly 1.4 million excess deaths took place during the height of the pandemic. Though the senior population accounted for the majority of these deaths, those aged 25 to 64 saw the largest relative increase in mortality.

During the pandemic, the core adult population saw a 20% increase from usual mortality rates, while seniors – who have a higher mortality rate to begin with – saw a 13% increase.

As a result, while the pandemic hit the vulnerable elderly population hard, “this really tells a somewhat different story that a lot of unexpected death was in younger populations,” said Tasce Bongiovanni, author on the study and acute care and trauma surgeon at the University of California at San Francisco. This is especially true for Native Hawaiian and other Pacific Islander populations, where people aged 65 and younger accounted for more than 70% of the excess deaths within these communities.

Across all age groups in the United States, American Indian, Alaskan Native and Hispanic communities saw the largest increases in deaths compared to usual values.

Among those 25 and younger, Black people accounted for more than 50% of the excess deaths, even though they represent about 14% of the U.S. population. In contrast, no excess deaths were recorded among White or Asian people in this age group.

“If you look through decades of our history here in the United States, sadly, we see these racial disparities in chronic diseases and mortality and hospitalization playing out,” said Utibe Essien, author on the study and assistant professor of medicine at UCLA.

The authors emphasize that their findings are not the result of genetic differences across the populations they studied. Rather, they call attention to the ways structural racism makes it difficult for some groups to access health care and trust in it, as many communities of color have been historically mistreated by the medical system.

“Work is just a totally key part of this story,” said Elizabeth Wrigley-Field, a demographer and associate professor of sociology at the University of Minnesota. She explained that some workers were put at a higher risk of contracting COVID and transmitting it to others, especially if they lived in multigenerational homes. A preprint study from November 2020 found that Black and Latino front-line workers were less likely than White and Asian workers to have adequate protections against COVID.

Social drivers of health, which include factors such as financial stability and access to quality education, primary care and housing, play a huge role in the health disparities that exist between different groups. Improving these drivers requires addressing long standing inequities in all sectors of society, said the researchers who called upon those with power and influence to take action.

“It can’t just come from the health care system,” Bongiovanni said. “It has to come from our community and our government.”