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U.S. Racial Inequality May Be as Deadly as the Coronavirus

The mortality rate for Black Americans in non-pandemic years is higher than the mortality rate for white Americans who died from COVID-19 and all other causes in 2020.

Coronavirus Pandemic Temporarily Shortens Average U.S. Lifespan by About a Year

While the pandemic is shortening the average U.S. lifespan—temporarily—its effects will be felt most heavily by Black Americans, whose mortality rate in ordinary years is higher than the rate for white Americans during the pandemic. Each coronavirus-related death will likely impact about nine close family members.

These impacts are among the findings of new research supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) that aims to put the pandemic’s magnitude in context and inform responses.

Extreme Racial Inequality in COVID-19 Deaths Layers on Top of Existing Stark Disparities

Black Americans experience a higher mortality rate every year than white Americans are experiencing during the coronavirus pandemic, finds Elizabeth Wrigley-Field of the University of Minnesota.Her analysis focuses on death rates and compares the scale of this pandemic to racial inequality, which she calls “another U.S. catastrophe.”

Using demographic models, Wrigley-Field estimates how many deaths of white Americans would be needed to raise the white age-adjusted mortality rate to the best-ever (lowest) Black age-adjusted rate.

At least 400,000 excess deaths of white Americans—deaths above and beyond the number expected in a non-pandemic year—would be needed to reach the best mortality rate ever recorded for Black Americans, which occurred in 2014, she finds.

Black Americans’ age-adjusted, confirmed COVID-19 deaths are more than 2.5 times higher than that of white Americans, she reports.2

Social factors rather than innate vulnerabilities drive these mortality differences: Mounting research suggests these stark disparities are driven by differences in exposure to the coronavirus. In particular, Black Americans are overrepresented in service jobs with high public contact and are particularly overrepresented among low-paid workers who may lack the power to demand adequate protection.3

For white mortality to reach levels that Black Americans experience outside of the pandemic, excess mortality in 2020 for white Americans would need to increase by 5.7 times the level of cumulative COVID-19 mortality reached in July 2020 (when the research findings were published), Wrigley-Field reports.

Final analysis of 2020 is likely to reveal “a deadly pandemic causing a spike in mortality for whites that nevertheless remains lower than the mortality Blacks experience routinely, outside of any pandemic,” she suggests.

This disparity in mortality rates has an impact on life expectancy during the pandemic as well. For white Americans, life expectancy in 2020 will remain higher than life expectancy for Black Americans has ever been unless nearly 700,000 excess white deaths occur, Wrigley-Field finds.4

“If Black disadvantage operates every year on the scale of whites’ experience of COVID-19, then so too should the tools we deploy to fight it,” she argues. “Our imagination should not be limited by how accustomed the United States is to profound racial inequality.”

COVID-19 Expected to Shorten the Average U.S. Lifespan in 2020

With the U.S. population as a whole experiencing nearly 350,000 COVID-19 deaths in 2020 and more to come in 2021, life expectancy may appear to be plummeting.5

But in estimating the magnitude of the pandemic, demographers at the University of California, Berkeley have found that COVID-19 is likely to shorten the average U.S. lifespan in 2020 by about a year.6

In July 2020, demographers Ronald Lee and Joshua Goldstein calculated the consequences of U.S. lives lost to COVID-19 that year in order to put COVID-19 mortality rates into historic, demographic, and economic perspective. They used two scenarios: One based on a projection of 1 million deaths for the year, the other on 250,000 deaths, which is closer to the current estimate of 345,700 deaths by Johns Hopkins University.7

One million deaths in 2020 would cut about three years off the average U.S. life expectancy, they conclude, while 250,000 deaths would reduce lifespans by about 10 months.

That said, without the societal efforts implemented to lessen COVID-19’s impact, 2 million deaths were projected by the end of 2020—a reduction of the average U.S. lifespan by five years, the researchers point out.

Their estimated drop in life expectancy is modest, in part because 250,000 deaths is not a large increase on top of the 3 million non-COVID-19 deaths expected for 2020. The study also notes that older people, who typically have fewer remaining years of life than others do, represent the most COVID-19 fatalities.

Still, while COVID-19 mortality rates in general remain lower than those of the 1918 Spanish flu pandemic, the toll of the coronavirus in the United States could be just as devastating as the country’s longer-lasting HIV and opioid epidemics if mitigation efforts fail, the researchers said.

“The death toll of COVID-19 is a terrible thing, both for those who lose their lives and for their family, friends, colleagues, and all whom their lives touched. Those are real people, not abstract statistics,” says Lee.

“But the population perspective helps put this tragedy in a broader context. As we work to contain the coronavirus, it is important to know that the United States has been through such mortality crises before,” he adds.

About Nine Close Relatives Suffer Grief With Each COVID-19 Fatality

The ripple effects of each COVID-19 death will impact the mental and physical health of about nine surviving close family members, a study of kinship networks shows.8

For example, when 190,000 people were dead from the disease in September 2020, 1.7 million Americans experienced the loss of a close relative, explains Ashton Verdery of Penn State University. A kinship network includes grandparents, parents, siblings, spouses, and children. Black Americans had a slightly higher number of close relatives than white Americans, averaging an estimated 9.2 people compared with 8.9, they found.

If 1 million people eventually die from COVID-19, then 8.9 million—or about 3 out of 100 Americans—would be in mourning.

These findings can help raise awareness about the scale of the disease and the ripple effects that deaths may have on a community, as well as prepare officials and business leaders to manage those effects, according to Verdery.

“It’s very helpful to have a sense of the potential impacts that the pandemic could have,” he says. “And, for employers, it calls attention to policies around family leave and paid leave. At the federal level, it might inform officials about possible extensions for FMLA (Family and Medical Leave Act). There could also be some implications for caretaking. For example, a lot of children grow up in grandparent-led houses and they would be impacted.”

Many people are also facing the loss of a close loved one at a younger age because of the disease, according to Verdery, who worked with Emily Smith-Greenaway of the University of Southern California, Rachel Margolis of the University of Western Ontario, and Jonathan K. Daw at Penn State.

“There are a substantial number of people who may be losing parents that we would consider younger adults and a substantial number of people may be losing spouses who are in their 50s or 60s,” he suggests.

Their findings could help local officials understand and prepare for the waves of grief that may affect specific geographic areas and regions of the country.


This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Yasmin Anwar of the University of California Berkeley and Matt Swayne of Penn State University contributed to this article. The work of researchers from the following NICHD-funded Population Dynamics Research Centers was highlighted: University of California, Berkeley (2P2CHD073964-05A1); University of Minnesota (5P2CHD041023-19); and Penn State University (5P2CHD041025-19).




A list of newly published research on the pandemic by NICHD Population Dynamics Research Centers can be found here.



References

  1. Elizabeth Wrigley-Field, “U.S. Racial Inequality May Be as Deadly as COVID-19,” Proceedings of the National Academies of Sciences 117, no. 36 (2020): 21854-6.
  2. Centers for Disease Control and Prevention, “COVID-19 Hospitalization and Death by Race/Ethnicity,” updated Nov. 30, 2020, https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html.
  3. Noreen Goldman et al., “Racial and Ethnic Differentials in COVID-19-Related Job Exposures by Occupational Status in the US,” MedRxiv (2020), https://doi.org/10.1101/2020.11.13.20231431.
  4. This study does not examine life expectancy for non-Hispanic Black Americans and non-Hispanic White Americans separately by sex. PRB notes that in 2017, non-Hispanic Black females had a longer life expectancy (78.1 years) than non-Hispanic White males (76.1 years). Data on life expectancy are from Kenneth D. Kochanek et al., “Deaths: Final Data for 2017,” National Vital Statistics Reports 68, no. 9 (2019).
  5. Johns Hopkins University, Coronavirus Resource Center, accessed on Jan. 4, 2021, https://coronavirus.jhu.edu/us-map.
  6. Joshua R. Goldstein and Ronald D. Lee, “Demographic Perspectives on the Mortality of COVID-19 and Other Epidemics,” Proceedings of the National Academies of Sciences 117, no. 36 (2020): 22035-41.
  7. Johns Hopkins University, Coronavirus Resource Center, accessed on Jan. 4, 2021, https://coronavirus.jhu.edu/us-map.
  8. Ashton M. Verdery et al., “Tracking the Reach of COVID-19 Kin Loss With a Bereavement Multiplier Applied to the United States,” Proceedings of the National Academies of Sciences 117, no. 30 (2020): 17695-701.