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The COVID Excess Mortality Percentage and Racial-Ethnic Disparities in COVID Mortality: Evidence from Indiana and Wisconsin (WP-22-45)

Vladimir Atanasov, Paula Natalia Barreto Parra, Lorenzo Franchi, Jeffrey Whittle, John Meurer, Qian (Eric) Luo, Andy Yuan, Ruohao Zhang, and Bernard Black

Importance: COVID-19 mortality rates increase with age, are higher among men than women, and vary across racial/ethnic groups, but this is also true for other natural causes of death. The authors develop a new measure of COVID-19 mortality burden, the COVID Excess Mortality Percentage (CEMP), defined as COVID-19 deaths as a fraction of all deaths from natural causes other than COVID-19. This measure can control for the effects of underlying population characteristics, including general population health, age, gender, race/ethnicity, and zip-code-level socioeconomic status (zip-SES) in predicting the COVID-19 mortality burden. Objective: They use CEMP to study how COVID-19 mortality varies by age, gender, race/ethnicity, and zip-SES and between the pre-vaccine and vaccine-available periods. Design: Retrospective analysis of all deaths from natural causes. Setting: Indiana and Wisconsin. Participants: All adult decedents from natural causes over the pandemic period from April 2020-March 2022. Exposure: Demographic factors and vaccine availability. Main Outcome and Measures: They report CEMP within sub-populations defined by age, gender, and race/ethnicity during the pre-vaccine (April 2020-March 2021) and vaccine-available (April 2021-March 2022) periods, and odds ratios from multivariable logistic regression.

Results: CEMP is broadly similar for men and women and rises gradually with age during the pre-vaccine period, but peaks at age 40-49 during the vaccine-available period. Racial/ethnic disparities can be very high, especially for Hispanics in the pre-vaccine period, with CEMP ratios for Hispanics to non-Hispanic Whites as high as 9:1 for men aged 50-59, and higher for men than for women. CEMP disparities were smaller but substantial for other minorities and declined with age after 60+. Differences in zip-SES and education explain only a small part of these disparities. National results for 2020 are consistent with our Indiana-Wisconsin findings.

Conclusions and Relevance: The authors studied COVID-19 mortality using a new measure that controls for non- COVID natural mortality rates. This approach is important in understanding racial/ethnic disparities in COVID-19 mortality. Disparities have been observed before, but not the very high Hispanic/White ratios we find for younger and middle-aged persons, especially men. Explanations for these disparities must account for age, gender, and time variation.

Key Points: Question. By how much did COVID-19 increase mortality rates; how did this vary with age, gender, and race/ethnicity; and with whether vaccines were available? Findings. The COVID Excess Mortality Percentage (CEMP) rose with age during the pre- vaccine period, but peaked at ages 40-49 in the vaccine-available period. Pre-vaccine CEMP rates were dramatically higher for Hispanics than non-Hispanic Whites; especially non-elderly men, and were also elevated for non-elderly Blacks and “other” race persons. Disparities shrank in the vaccine-available period. Meaning. The large racial/ethnic disparities in non-elderly CEMP rates, are not explained by underlying health status and call for detailed investigation.

Vladimir Atanasov, Brinkley-Mason Term Professor of Business, William & Mary

Paula Natalia Barreto Parra, Department of Economics, University of Illinois, Urbana-Champaign

Lorenzo Franchi, Post-Baccalaureate Research Fellow, Pritzker School of Law, Northwestern University

Jeffrey Whittle, Professor of Medicine, Medical College of Wisconsin

John Meurer, Professor of Pediatrics and Community Health, Medical College of Wisconsin

Qian (Eric) Luo, Assistant Research Professor, Milken Institute School of Public Health, George Washington University

Andy Yuan, Postdoctoral Scholar, Pritzker School of Law, Northwestern University

Ruohao Zhang, Assistant Professor of Data Science, Economics and Environmental Studies, Centre College

Bernard Black, Nicholas J. Chabraja Professor and IPR Associate, Northwestern University

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