Covid-19 disparities among Black adults vanished last fall.
After being the hardest hit group in the first wave, Black adults mounted a remarkable recovery.
By now, most of us are aware of the striking racial and ethnic disparities in Covid-19 mortality. The same has been true of an important metric in epidemiology known as excess mortality. Excess mortality is the number of deaths (or the percent increase) from all causes that surpasses the expected number of deaths during any period. Through almost every lens, including excess mortality, people of color have suffered disproportionately during this pandemic.
Yesterday, my colleagues and I published a paper on this topic in the Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, which is the most influential epidemiology journal in the world. Using state-of-the-art methods, we took a sweeping look at excess mortality in the United States in 2020, from the start of the Covid-19 pandemic, through the beginning of 2021. (Excess mortality is the purest measure of the overall effect of the Covid-19 pandemic—better even than simply counting the number of Covid-19 deaths—because it does not rely on whether there was adequate testing in any given time or place. Excess mortality measures the bottom-line effects of the pandemic.)
Our research shows, unsurprisingly, that disparities in excess mortality occurred both in younger adults (ages 25-64) and older adults (ages 65 and over) last year, most of which extended into 2021.
But something surprised me when I first saw the data readouts. Black adults, who had been the hardest hit demographic in the first wave of the pandemic, mounted a remarkable turnaround. During the summer wave, the disparities were still bad, but less so. Then in the fall, Black adults, particularly those ages 65 and over, actually experienced the lowest amount of excess mortality of any race or ethnicity, with excess mortality frequently matching and often besting rates recorded among White adults.
Take a look at the data visualizations that we created exclusively for Inside Medicine above.‡ These graphs show weekly excess mortality among just the Black and White populations ages 65 and over, from the start of 2020 through the end of June of 2021 (our CDC paper includes data for other races and ethnicities, and other age groups as well). Look at the astronomical devastation that the first wave of the Covid-19 wrought on Black adults over the age of 65, particularly in comparison to White adults in the same age bracket. Notice that during the second wave, the disparities were there, but were not as extreme. Then in the fall, the differences between Black and White excess deaths are essentially non-existent. (Overall, the fall wave was worse than the summer wave for all demographics, but much less so for Black people). As 2021 unfolded, the disparities re-appeared, but not as large and not for long. By the end of the “pre-Delta era”, there was no excess mortality among either Black or White people living in the United States.
Why did this happen? There are many potential explanations. In the coming days, I’ll publish another Inside Medicine. In it, I’ll share more data with you plus insights and analyses from some leading experts in the field and some of my own thoughts. What I can tell you is that these graphs and these data are not simply “artifacts” due to regional differences. I know because I checked into that. Demographic differences in the various regions where major outbreaks occurred may have had some contribution to the effects that we see in the graphs. But when I drilled down into sub-regions of the United States, I found that the improvements in excess death disparities in the Black population occurred within individual regions of the country. Meanwhile, in those same areas, other races and ethnicities often did not fare as well in the summer or fall. It’s complicated, to be sure, but I am convinced that this signal is “real” and that it means something important about how the Black community was able to respond to this crisis, almost in real time.
I plan to publish another newsletter on this topic in the coming days, as I mentioned. In the meantime, I am interested in what you make of these stark changes.
What do you think accounts for this turnaround? Please share your thoughts below.
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‡Special thanks to Dr. Kristen Panthagani for data visualization created for this Inside Medicine article, to Dr. Lauren Rossen of the National Center for Health Statistics at the CDC (my primary co-author on the CDC manuscript), my colleagues at Harvard Medical School/Brigham and Women’s Hospital, and my collaborators at the Yale School of Medicine’s Center for Outcomes Research and Evaluation, led by Dr. Harlan Krumholz.