Disparities in COVID-19 mortality in the United States, 2020–2023

Abstract

Background: The COVID-19 pandemic disproportionately affected various demographics and regions in the United States. Understanding disparities in COVID-19 mortality is essential for promoting health equity and guiding future responses. Objective: To examine demographic and regional disparities in age-adjusted and proportionate COVID-19 mortality in the US from 2020 to 2023. Design, setting, and participants: In this repeated cross-sectional study, data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database were used to analyze death certificates from 2020 to 2023 for COVID-19-related mortality among persons aged ≥ 15 years in the U.S. Main outcome measures: Age-adjusted mortality rate (AAMR) per 100,000 persons, Rate ratio (with 95% CI), and proportionate mortality of COVID-19, calculated using descriptive statistics. Results: From 2020 to 2023, 1,167,362 (8.91%) of 13,098,787 total deaths in the U.S. were attributed to COVID-19. The AAMR peaked in 2021 at 147.0 (95% CI: 146.6–147.5) per 100,000, with 13.45% of all deaths related to COVID-19, decreasing to 23.1 (2.49%) by 2023. Males exhibited a 1.56-fold higher AAMR than females. Non-Hispanic (NH) American Indian/Alaska Native experienced the highest cumulative AAMR (154), followed by NH Native Hawaiian/Pacific Islander (124.2) and NH African American (123.9) populations. Hispanics had the highest proportionate mortality, with COVID-19 contributing to 23.55% of all deaths in 2021. The oldest age group (≥ 75 years) had the highest cumulative AAMR, 71.6 times higher compared to the youngest group (15–44 years), whereas the highest proportionate mortality was seen in middle-aged adults (45–74 years). Regionally, the Southern U.S. census region recorded the highest cumulative and annual AAMR, except for the Northeast, in 2020. Conclusion: From 2020 to 2023, males, older adults, and racial/ethnic minority groups, notably NH AI/AN, NH NH/PI, NH African American, and Hispanic populations, experienced higher COVID-19 mortality. Regionally, the Southern U.S. Census region had the highest COVID-19 mortality, except for the Northeast, in 2020. These disparities underscore the importance of implementing equitable public health strategies and ensuring preparedness for future health crises. Clinical trial number: Not applicable