Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

  1. Jay J. Xu
  2. Jarvis T. Chen
  3. Thomas R. Belin
  4. Ronald S. Brookmeyer
  5. Marc A. Suchard
  6. Christina M. Ramirez

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Abstract

The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios—anchoring comparisons to non-Hispanic Whites—in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.

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  1. Version published to 10.3390/ijerph18062921
  2. ScreenIT

    SciScore for 10.1101/2021.01.28.21249411: (What is this?)

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

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Experimental Models: Organisms/Strains
    SentencesResources
    The following 8 racial/ethnic groups are used in the NCHS Race/Ethnicity Data: non-Hispanic White (NH White), non-Hispanic Black (NH Black), Hispanic, non-Hispanic Asian (NH Asian), non-Hispanic American Indian or Alaska Native (NH AIAN), non-Hispanic Native Hawaiian or Other Pacific Islander, non-Hispanic Two or More Races, and Unknown.
    non-Hispanic White
    suggested: None
    Specifically, when the estimand of interest primarily concerns racial/ethnic group r (i.e., total YPLL for racial/ethnic group r, percentage of total YPLL for racial/ethnic group r, age-adjusted YPLL rate for racial/ethnic group r, and age-adjusted r-to-NH White YPLL RR), we assume all deaths among the Unknown racial/ethnic group are members of racial/ethnic group r and appropriately combine death counts within their age intervals before exhaustively enumerating all possible mortality datasets, simulating ages at death for each individual for each mortality dataset, calculating a point estimate from the corresponding simulated YPLL values for each mortality datset, and storing the maximum point estimate across mortality datasets at each MC iteration.
    r-to-NH White
    suggested: None

    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:
    While an important limitation of our analyses is that they are descriptive in nature, the sheer magnitude of many of the estimated state-level disparities in our analyses speaks to the degree of urgency for communities of color in relation to the U.S. COVID-19 epidemic. At the time of writing, two COVID-19 vaccines, one manufactured by Pfizer, Inc./BioNTech [85] and the other by ModernaTX, Inc. [86], have been granted emergency use authorization by the U.S. Food and Drug Administration, with several vaccine candidates in Phase III clinical trials. Vaccine distribution strategy has been the subject of rigorous public policy debate, with varying opinions on which segments of the population to prioritize for vaccination [87,88]. In any case, it is critical that communities of color particularly devastated by the U.S. COVID-19 epidemic have direct and equitable access to COVID-19 vaccines. Nevertheless, while vaccination serves as the most potent tool to fight COVID-19, both vaccine-based and non-pharmaceutical interventions should be pursued to prevent the further devastation of communities of color from the U.S. COVID-19 epidemic and to confront future public health crises.

    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.

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  3. Version published to 10.1101/2021.01.28.21249411v1 on medRxiv