During the first year of the pandemic, U.S. Black and Latinx persons had lower case fatality rates (CFRs) overall than their white counterparts. However, after adjusting for age, Black and Latinx persons under age 65 had higher CFRs, a partial example of Simpson's paradox.
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The racial and ethnic disparity in CFR was highest among the youngest adults (18–49).
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There is considerable variability in observed CFR between states, likely due to differences in testing rates and reporting.
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More complete national data are needed to fully understand racial and ethnic disparities in the impact of the pandemic.
ABSTRACT
Purpose
During the initial 12 months of the pandemic, racial and ethnic disparities in COVID-19 death rates received considerable attention but it has been unclear whether disparities in death rates were due to disparities in case fatality rates (CFRs), incidence rates or both. We examined differences in observed COVID-19 CFRs between U.S. White, Black/African American, and Latinx individuals during this period.
Methods
Using data from the COVID Tracking Project and the Centers for Disease Control and Prevention COVID-19 Case Surveillance Public Use dataset, we calculated CFR ratios comparing Black and Latinx to White individuals, both overall and separately by age group. We also used a model of monthly COVID-19 deaths to estimate CFR ratios, adjusting for age, gender, and differences across states and time.
Results
Overall Black and Latinx individuals had lower CFRs than their White counterparts. However, when adjusting for age, Black and Latinx had higher CFRs than White individuals among those younger than 65. CFRs varied substantially across states and time.
Conclusions
Disparities in COVID-19 case fatality among U.S. Black and Latinx individuals under age 65 were evident during the first year of the pandemic. Understanding racial and ethnic differences in COVID-19 CFRs is challenging due to limitations in available data.
Keywords
Covid-19
Health disparities
Simpson's paradox
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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
