Variation in National COVID-19 Mortality Rates Across Asian Subgroups in the United States, 2020

  1. Jay J. Xu

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Abstract

Provisional U.S. national COVID-19 mortality data for the year 2020 analyzed by the CDC in March 2021 indicated that non-Hispanic Asians fared markedly better overall than other racial/ethnic minority groups–and marginally better than non-Hispanic Whites–in terms of age-adjusted mortality rates. However, Asians in the United States are composed of diverse array of origin subgroups with highly varying social, economic, and environmental experiences, which influence health outcomes. As such, lumping all Asians together into a single category can mask meaningful health disparities among more vulnerable Asian subgroups. To date, there has not been a national-level analysis of COVID-19 mortality outcomes between Asian subgroups. Utilizing final multiple cause of death data for 2020 and population projections from the U.S. Census Bureau’s Current Population Survey Annual Social and Economic Supplement for 2020, crude and age-adjusted national COVID-19 mortality rates, both overall and stratified by sex, were calculated for the six major single-race Asian origin subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and a catch-all seventh category that comprises the remaining Asian subgroups (Other Asians), contrasting them to the corresponding mortality rates of other racial/ethnic groups. A substantially more nuanced picture emerges when disaggregating Asians into its diverse origin subgroups and stratifying by sex, with Filipino males and Asian males outside of the six major Asian subgroups in particular experiencing markedly higher age-adjusted mortality rates than their White male counterparts, whether comparisons were restricted to their non-Hispanic subsets or not. During the COVID-19 pandemic and in the post-pandemic recovery, it is imperative not to overlook the health needs of vulnerable Asian populations. Public health strategies to mitigate the effects of COVID-19 must avoid viewing Asians as a monolithic entity and recognize the heterogeneous risk profiles within the U.S. Asian population.

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    SciScore for 10.1101/2022.04.02.22273341: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of the current analysis include the possibility of COVID-19 deaths that occurred in 2020 among whom COVID-19 went undiagnosed, as well as the possibility of racial/ethnic misclassification of COVID-19 deaths on official death certificates. A 2016 CDC study estimated a race misclassification rate of 3% on death certificates for Asians [40]. The same report, however, estimated race misclassification for AIAN’s to be 40%, which has been a long-standing and persistent problem [41–48]. Asian subgroup misclassification on death certificates among Asian decedents is also a potential limitation, but its current extent is unclear. Moreover, the current analysis is based on COVID-19 deaths that occurred in 2020, at the tail end of which the U.S. vaccination campaign began (December 14) [49]. As such, racial/ethnic patterns in mortality outcomes observed in the current analysis may not necessarily reflect patterns that unfolded during later stages of the COVID-19 pandemic in 2021 and 2022 when COVID-19 vaccines became widely available and when the more transmissible and virulent Alpha, Delta, and Omicron SARS-CoV-2 variants emerged and successively usurped previously dominant variants. All mortality rates presented in the current analysis also contain the caveat that the denominators used to calculate them are based on population projections derived from a national survey, namely the CPS ASEC, which in fact experienced significant operational challenges in 2020 as a result o...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2022.04.02.22273341 on medRxiv