Variation in racial/ethnic disparities in COVID-19 mortality by age in the United States: A cross-sectional study.
Variation in racial/ethnic disparities in COVID-19 mortality by age in the United States: A cross-sectional study.
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DOI：
10.1371/journal.pmed.1003402
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发表时间：
2020-10
期刊：
影响因子：
15.8
通讯作者：
Krieger N
中科院分区：
文献类型：
--
作者：
Bassett MT;Chen JT;Krieger N
在美国，与非西班牙裔白人（NHW）相比，非西班牙裔黑人（NHB）、西班牙裔和非西班牙裔美洲印第安人/阿拉斯加原住民（NHAIAN）人口的COVID-19死亡率高于非西班牙裔白人（NHW），但死亡年龄的种族/民族差异尚不清楚。按种族/族裔群体发布的全国COVID-19死亡数据现在允许分析这些群体和非西班牙裔亚裔或太平洋岛民（NHAPI）人口的特定年龄死亡率。我们的目标是按种族/民族检查年龄特异性COVID-19死亡率的变化，并使用潜在生命损失年数（YPLL）计算这种死亡率的影响。这项横断面研究使用了最近公开的美国2019冠状病毒病死亡数据，报告了2020年2月1日至2020年7月22日期间的种族/民族。人口数据来自美国人口普查。截至2020年7月22日，新冠肺炎死亡人数为NHW 68377人，NHB 29476人，西班牙裔23256人，NHAIAN 1143人，NHAPI 6468人；相应的人口规模分别为1.864亿、4060万、260万、1950万、5770万。与NHW相关的年龄标准化比率NHB为3.6 (95% CI 3.5, 3.8; p < 0.001)， Hispanic为2.8 (95% CI 2.7, 3.0; p < 0.001)， NHAIAN为2.2 (95% CI 1.8, 2.6; p < 0.001)， NHAP人群为1.6 （95% CI 1.4, 1.7; p < 0.001）。相比之下，25-34岁人群的NHB与NHW的比值为7.1 (95% CI 5.8, 8.7; p < 0.001)， 35-44岁人群的NHB与NHW的比值为9.0 (95% CI 7.9, 10.2; p < 0.001)， 45-54岁人群的NHB与NHW的比值为7.4 （95% CI 6.9, 7.9; p < 0.001）。即使在老年人中，NHB比率也在2.0到5.7之间。同样，西班牙裔人口与非西班牙裔人口的比率为7.0 (95% CI 5.8, 8.7; p < 0.001), 8.8 （95% CI 7.8, 9.9; p < 0.001）和7.0 (95% CI 6.6, 7.5; p < 0.001)，其余比率范围为1.4至5.0。NHAIAN的发病率在74岁之前也同样高。在NHAPI人群中，25-74岁人群的比率为2.0 - 2.8,75-84岁和85岁以上人群的比率分别为1.6和1.2。因此，尽管NHW人口更大，但NHB和西班牙裔人口在65岁之前经历的YPLL比NHW人口多，NHB和西班牙裔人口的比例分别为4.6:1和3.2:1。研究的局限性包括，在接收疾病控制和预防中心收到的完整死亡证明并将其传递给国家卫生服务中心时，可能存在滞后时间，因此与各州仪表板上报告的数据相比，在获取死亡总数方面存在滞后。在这项研究中，我们观察到年龄特异性死亡率的种族差异，而不是单独检查年龄标准化死亡率。这些发现表明了检查特定年龄死亡率的重要性，并强调了年龄标准化如何掩盖年龄层内的极端变化。为了避免忽视这种差异，允许特定年龄分析的数据应该定期公开。玛丽·巴塞特（Mary Bassett）及其同事分析了美国关于COVID-19死亡的数据，以确定除了死亡率较高外，种族和少数民族是否也在更年轻时死亡。来自媒体报道和当地卫生部门报告的数据表明，与非西班牙裔白人人口相比，非西班牙裔黑人、西班牙裔和非西班牙裔美国印第安人或阿拉斯加原住民的COVID-19死亡率要高得多。但是，目前还没有全国性的数据来确定，除了死亡率更高之外，这些群体的死亡年龄是否也更小。利用最近发布的按种族/族裔和年龄划分的COVID-19死亡国家数据，以及美国人口普查数据，我们通过计算上述群体以及非西班牙裔亚洲人或太平洋岛民（5个人口普查定义的可获得数据的群体）的特定年龄死亡率指标，探索了死亡风险的变化。我们发现，与非西班牙裔白人相比，所有年龄组的COVID-19死亡人数都多。虽然在所有种族/族裔群体中，大多数死亡发生在老年人身上，但在有色人种中，65岁以前较年轻的人也有惊人的死亡。非西班牙裔黑人和西班牙裔人口在65岁之前的寿命损失比非西班牙裔白人多，尽管这些群体的规模较小。仔细检查特定年龄的死亡率，我们发现，相比之下，对于进入中年的年轻人，非西班牙裔黑人、西班牙裔和非西班牙裔美国印第安人或阿拉斯加原住民人口死于COVID-19的风险要比非西班牙裔白人高得多。这些数据支持这样的结论，即美国有色人种死于COVID-19的年龄更小，死亡率高于非西班牙裔白人。加强对感染的保护，包括确保工作场所的保护，可能与预防工作年龄成年人感染COVID-19有关。
In the United States, non-Hispanic Black (NHB), Hispanic, and non-Hispanic American Indian/Alaska Native (NHAIAN) populations experience excess COVID-19 mortality, compared to the non-Hispanic White (NHW) population, but racial/ethnic differences in age at death are not known. The release of national COVID-19 death data by racial/ethnic group now permits analysis of age-specific mortality rates for these groups and the non-Hispanic Asian or Pacific Islander (NHAPI) population. Our objectives were to examine variation in age-specific COVID-19 mortality rates by racial/ethnicity and to calculate the impact of this mortality using years of potential life lost (YPLL). This cross-sectional study used the recently publicly available data on US COVID-19 deaths with reported race/ethnicity, for the time period February 1, 2020, to July 22, 2020. Population data were drawn from the US Census. As of July 22, 2020, the number of COVID-19 deaths equaled 68,377 for NHW, 29,476 for NHB, 23,256 for Hispanic, 1,143 for NHAIAN, and 6,468 for NHAPI populations; the corresponding population sizes were 186.4 million, 40.6 million, 2.6 million, 19.5 million, and 57.7 million. Age-standardized rate ratios relative to NHW were 3.6 (95% CI 3.5, 3.8; p < 0.001) for NHB, 2.8 (95% CI 2.7, 3.0; p < 0.001) for Hispanic, 2.2 (95% CI 1.8, 2.6; p < 0.001) for NHAIAN, and 1.6 (95% CI 1.4, 1.7; p < 0.001) for NHAP populations. By contrast, NHB rate ratios relative to NHW were 7.1 (95% CI 5.8, 8.7; p < 0.001) for persons aged 25–34 years, 9.0 (95% CI 7.9, 10.2; p < 0.001) for persons aged 35–44 years, and 7.4 (95% CI 6.9, 7.9; p < 0.001) for persons aged 45–54 years. Even at older ages, NHB rate ratios were between 2.0 and 5.7. Similarly, rate ratios for the Hispanic versus NHW population were 7.0 (95% CI 5.8, 8.7; p < 0.001), 8.8 (95% CI 7.8, 9.9; p < 0.001), and 7.0 (95% CI 6.6, 7.5; p < 0.001) for the corresponding age strata above, with remaining rate ratios ranging from 1.4 to 5.0. Rate ratios for NHAIAN were similarly high through age 74 years. Among NHAPI persons, rate ratios ranged from 2.0 to 2.8 for persons aged 25–74 years and were 1.6 and 1.2 for persons aged 75–84 and 85+ years, respectively. As a consequence, more YPLL before age 65 were experienced by the NHB and Hispanic populations than the NHW population—despite the fact that the NHW population is larger—with a ratio of 4.6:1 and 3.2:1, respectively, for NHB and Hispanic persons. Study limitations include likely lag time in receipt of completed death certificates received by the Centers for Disease Control and Prevention for transmission to NCHS, with consequent lag in capturing the total number of deaths compared to data reported on state dashboards. In this study, we observed racial variation in age-specific mortality rates not fully captured with examination of age-standardized rates alone. These findings suggest the importance of examining age-specific mortality rates and underscores how age standardization can obscure extreme variations within age strata. To avoid overlooking such variation, data that permit age-specific analyses should be routinely publicly available. Mary Bassett and colleagues anzlyze US data on COVID-19 deaths to determine if, in addition to dying at higher rates, racial and ethnic minorities are also dying at younger ages. Data from media coverage and local health department reports suggest that, as compared to the non-Hispanic White population, COVID-19 mortality rates are substantially higher among non-Hispanic Black, Hispanic, and non-Hispanic American Indian or Alaska Native populations. But no national data have been available to determine whether, in addition to dying at higher rates, these groups also die at younger ages. Using recently released national data on COVID-19 deaths by racial/ethnic group and age, along with US Census population data, we explored variation in mortality risk by calculating age-specific mortality measures in the above groups as well as in the non-Hispanic Asian or Pacific Islander population, the 5 census-defined groups for which data are available. We found that for all groups, as compared to the non-Hispanic White population, there were excess COVID-19 deaths across all ages. Although for all racial/ethnic groups, most deaths occurred at older ages, there was also striking loss of life at younger ages, before age 65, among people of color. More years of life were lost before 65 years among the non-Hispanic Black and Hispanic populations, despite the smaller size of these groups, than among the non-Hispanic White population. Scrutinizing age-specific mortality rates, we found that for young adults into midlife, comparatively, the non-Hispanic Black, Hispanic, and non-Hispanic American Indian or Alaska Native populations had a much higher risk of death from COVID-19 than the non-Hispanic White population. These data support the conclusion that US populations of color die of COVID-19 at younger ages as well as at higher rates than the non-Hispanic White population. Enhancing protection from infection, including assurance of workplace protections, may be relevant to prevention of COVID-19 in working-age adults.
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