Race, ethnicity and mortality in the United States during the first year of the COVID-19 pandemic: an assessment

Abstract

The fact that a disproportionate share of the disease burden from COVID-19, including mortality, has been borne by racial and ethnic minority communities is well documented. The purpose of this paper is to reassess the “race/ethnicity effect” in COVID-19 mortality in the United States. Using an ecological regression framework and county-level data, the study aims to make two contributions. First, it estimates the race/ethnicity effect for all major racial/ethnic groups at four important junctures during the first year of the pandemic. In doing so, it seeks to provide the fullest possible picture of the nature and evolution of the race/ethnicity effect. Second, it estimates the race/ethnicity effect net of basic socioeconomic factors (SEF). This helps to identify the likely mechanisms through which the race/ethnicity effect operates. Racial/ethnic composition is flexibly measured in two ways—by percentage contributions to county population and by indicators of group plurality. The ecological regressions revealed a positive association between the size of three racial/ethnic groups—non-Hispanic Blacks, non-Hispanic American Indian and Alaskan Natives (AIAN) and Hispanics—and county mortality, although the association was stronger and more consistent for Blacks and AIANs. Furthermore, accounting for basic SEF had different impacts on the race/ethnicity-mortality association for the three groups. For Hispanics, it was almost fully mediated. For Blacks, it decreased but remained statistically significant [62–6% higher mortality associated with a 1-standard deviation increase in Black share of county population; 2.3–1.1 times higher mortality in the average Black plurality county]. For AIANs, it was largely unaffected or even increased [44–10% higher mortality associated with a 1-standard deviation increase in AIAN share; 6.2–1.8 times higher mortality in AIAN plurality county). For all groups, the race/ethnicity effect generally decreased as the pandemic wore on during the first year.