Racial Disparities in Coronavirus Disease 2019 (COVID-19) Mortality Are Driven by Unequal Infection Risks

Abstract Background As of 1 November 2020, there have been >230 000 deaths and 9 million confirmed and probable cases attributable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States. However, this overwhelming toll has not been distributed equally, with geographic, race/ethnic, age, and socioeconomic disparities in exposure and mortality defining features of the US coronavirus disease 2019 (COVID-19) epidemic. Methods We used individual-level COVID-19 incidence and mortality data from the state of Michigan to estimate age-specific incidence and mortality rates by race/ethnic group. Data were analyzed using hierarchical Bayesian regression models, and model results were validated using posterior predictive checks. Results In crude and age-standardized analyses we found rates of incidence and mortality more than twice as high than for Whites for all groups except Native Americans. Blacks experienced the greatest burden of confirmed and probable COVID-19 (age-standardized incidence, 1626/100 000 population) and mortality (age-standardized mortality rate, 244/100 000). These rates reflect large disparities, as Blacks experienced age-standardized incidence and mortality rates 5.5 (95% posterior credible interval [CrI], 5.4–5.6) and 6.7 (95% CrI, 6.4–7.1) times higher than Whites, respectively. We found that the bulk of the disparity in mortality between Blacks and Whites is driven by dramatically higher rates of COVID-19 infection across all age groups, particularly among older adults, rather than age-specific variation in case-fatality rates. Conclusions This work suggests that well-documented racial disparities in COVID-19 mortality in hard-hit settings, such as Michigan, are driven primarily by variation in household, community, and workplace exposure rather than case-fatality rates.

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Racial disparities in COVID-19 mortality are driven by unequal infection risks.

10.1101/2020.09.10.20192369 ◽

2020 ◽

Cited By ~ 3

Author(s):

Jon Zelner ◽

Rob Trangucci ◽

Ramya Naraharisetti ◽

Alex Cao ◽

Ryan Malosh ◽

...

Keyword(s):

Racial Disparities ◽

Data Science ◽

Age Groups ◽

Case Fatality ◽

The United States ◽

Mortality Rates ◽

Bayesian Regression ◽

Mortality Data ◽

Incidence And Mortality ◽

The U.S

Background. As of August 5, 2020, there were more than 4.8M confirmed and probable cases and 159K deaths attributable to SARS-CoV-2 in the United States, with these numbers undoubtedly reflecting a significant underestimate of the true toll. Geographic, racial-ethnic, age and socioeconomic disparities in exposure and mortality are key features of the first and second wave of the U.S. COVID-19 epidemic. Methods. We used individual-level COVID-19 incidence and mortality data from the U.S. state of Michigan to estimate age-specific incidence and mortality rates by race/ethnic group. Data were analyzed using hierarchical Bayesian regression models, and model results were validated using posterior predictive checks. Findings. In crude and age-standardized analyses we found rates of incidence and mortality more than twice as high than Whites for all groups other than Native Americans. Of these, Blacks experienced the greatest burden of confirmed and probable COVID-19 infection (Age- standardized incidence = 1,644/100,000 population) and mortality (age-standardized mortality rate 251/100,000). These rates reflect large disparities, as Blacks experienced age-standardized incidence and mortality rates 5.6 (95% CI = 5.5, 5.7) and 6.9 (6.5, 7.3) times higher than Whites, respectively. We also found that the bulk of the disparity in mortality between Blacks and Whites is driven by dramatically higher rates of COVID-19 infection across all age groups, particularly among older adults, rather than age-specific variation in case-fatality rates. Interpretation. This work suggests that well-documented racial disparities in COVID-19 mortality in hard-hit settings, such as the U.S. state of Michigan, are driven primarily by variation in household, community and workplace exposure rather than case-fatality rates. Funding. This work was supported by a COVID-PODS grant from the Michigan Institute for Data Science (MIDAS) at the University of Michigan. The funding source had no role in the preparation of this manuscript.

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Diarrhoea morbidity and mortality in older children, adolescents, and adults

Epidemiology and Infection ◽

10.1017/s0950268810000592 ◽

2010 ◽

Vol 138 (9) ◽

pp. 1215-1226 ◽

Cited By ~ 51

Author(s):

C. L. FISCHER WALKER ◽

R. E. BLACK

Keyword(s):

Eastern Mediterranean ◽

Age Groups ◽

Eastern Mediterranean Region ◽

Mortality Rates ◽

Incidence Rates ◽

Morbidity And Mortality ◽

Mortality Data ◽

Older Children ◽

Incidence And Mortality ◽

Adolescents And Adults

SUMMARYDiarrhoea is a leading cause of morbidity and mortality yet diarrhoea specific incidence and mortality rates for older children, adolescents, and adults have not been systematically calculated for many countries. We conducted a systematic literature review to generate regional incidence rates by age and to summarize diarrhoea specific mortality rates for regions of the world with inadequate vital registration data. Diarrhoea morbidity rates range from 29·9 episodes/100 person-years for adults in the South East Asian region to 88·4 episodes/100 person-years in older children in the Eastern Mediterranean region and have remained unchanged in the last 30 years. Diarrhoea mortality rates decline as the child ages and remain relatively constant during adulthood. These data are critical for improving estimates worldwide and further highlight the need for improved diarrhoea specific morbidity and mortality data in these age groups.

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Age transition of tuberculosis incidence and mortality in Brazil

Revista de Saúde Pública ◽

10.1590/s0034-89102001000100012 ◽

2001 ◽

Vol 35 (1) ◽

pp. 81-87 ◽

Cited By ~ 31

Author(s):

Flávio Chaimowicz

Keyword(s):

Older People ◽

Demographic Transition ◽

Age Groups ◽

Population Data ◽

Mortality Rates ◽

Mortality Data ◽

Older Individuals ◽

Tuberculosis Incidence ◽

General Decline ◽

Incidence And Mortality

OBJECTIVE: Before the Aids pandemic, demographic transition and control programs prompted a shift in the age of incidence of tuberculosis from adults to older people in many countries. The objective of the study is to evaluate this transition in Brazil. METHODS: Tuberculosis incidence and mortality data from the Ministry of Health and population data from the Brazilian Bureau of Statistics were used to calculate age-specific incidence and mortality rates and medians. RESULTS: Among reported cases, the proportion of older people increased from 10.5% to 12% and the median age from 38 to 41 years between the period of 1986 and 1996. The smallest decrease in the incidence rate occurred in the 30--49 and 60+ age groups. The median age of death increased from 53 to 55 years between 1980 and 1996. The general decline in mortality rates from 1986 to 1991 became less evident in the 30+ age group during the period of 1991 to 1996. A direct correlation between age and mortality rates was observed. The largest proportion of bacteriologically unconfirmed cases occurred in older individuals. CONCLUSIONS: The incidence of tuberculosis has begun to shift to the older population. This shift results from the decline in the annual risk of infection as well as the demographic transition. An increase in reactivation tuberculosis in older people is expected, since this population will grow from 5% to 14% of the Brazilian population over the next 50 years. A progressive reduction in HIV-related cases in adults will most likely occur. The difficulty in diagnosing tuberculosis in old age leads to increased mortality.

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Adjustable Algorithmic Tool for Assessing the Effectiveness of Maternal Respiratory Syncytial Virus (RSV) Vaccination on Infant Mortality in Developing Countries

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2021/5536633 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Rachel Cevigney ◽

Christopher Leary ◽

Bernard Gonik

Keyword(s):

Developing Countries ◽

Infant Mortality ◽

Case Fatality ◽

The United States ◽

Mortality Rates ◽

Incidence Rates ◽

Acute Lower Respiratory Infection ◽

Maternal Child Health ◽

Incidence And Mortality ◽

Country Specific

Acute lower respiratory infection (ALRI) due to RSV is a common cause of global infant mortality, with most cases occurring in developing countries. Using data aggregated from priority countries as designated by the United States Agency for International Development’s (USAID) Maternal Child Health and Nutrition (MCHN) program, we created an adjustable algorithmic tool for visualizing the effectiveness of candidate maternal RSV vaccination on infant mortality. Country-specific estimates for disease burden and case fatality rates were computed based on established data. Country-specific RSV-ALRI incidence rates for infants 0-5 months were scaled based on the reported incidence rates for children 0-59 months. Using in-hospital mortality rates and predetermined “inflation factor,” we estimated the mortality of infants aged 0-5 months. Given implementation of a candidate maternal vaccination program, estimated reduction in infant RSV-ALRI incidence and mortality rates were calculated. User input is used to determine the coverage of the program and the efficacy of the vaccine. Using the generated algorithm, the overall reduction in infant mortality varied considerably depending on vaccine efficacy and distribution. Given a potential efficacy of 70% and a maternal distribution rate of 50% in every USAID MCHN priority country, annual RSV-ALRI-related infant mortality is estimated to be reduced by 14,862 cases. The absolute country-specific reduction is dependent on the number of live births; countries with the highest birth rates had the greatest impact on annual mortality reduction. The adjustable algorithm provides a standardized analytical tool in the evaluation of candidate maternal RSV vaccines. Ultimately, it can be used to guide public health initiatives, research funding, and policy implementation concerning the effectiveness of potential maternal RSV vaccination on reducing infant mortality.

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Epidemiological Characteristics of Pancreatic Cancer in China From 1990 to 2019

Cancer Control ◽

10.1177/10732748211051536 ◽

2021 ◽

Vol 28 ◽

pp. 107327482110515

Author(s):

Bo Zhu ◽

Xiaomei Wu ◽

Tianyu Guo ◽

Ning Guan ◽

Yefu Liu

Keyword(s):

Pancreatic Cancer ◽

Healthy Lifestyle ◽

Age Groups ◽

Mortality Rates ◽

Mortality Data ◽

Age Group ◽

Incidence And Mortality ◽

Rate Ratios ◽

Epidemiological Characteristics ◽

Incident Cases

Background Pancreatic cancer is an aggressive cancer and is predicted to become the second leading cause of cancer-related deaths in China. To understand the epidemic trend of pancreatic cancer and formulate targeted preventive measures, it is important to analyze the incidence and mortality of pancreatic cancer. Methods The incidence and mortality data of pancreatic cancer in China were obtained from Global Burden of Disease (GBD) data. We used joinpoint regression analysis to calculate the magnitude and direction of trends, and the age-period-cohort method to analyze the effects of chronological age, time period, and birth cohort. Results The age-standardized rates (ASRs) for both incidence and mortality of pancreatic cancer increased from 1990 to 2019, and were higher in males than females. The incidence and mortality rates have increased year by year in the age group above 25 years. The most common age group was 55–79 years, accounting for approximately 50% of all incident cases. In terms of incidence and mortality rates, the overall net drifts were above 0. The local drifts in all age groups were above 0 in both sexes and males, while the local drifts in the 15–39 age groups were below 0 in females. The longitudinal age curves increased with age, with higher incidence and mortality rates, mainly in older age groups. The period rate ratios increased by year. The cohort rate ratios showed an upward trend before 1970 and fluctuated after 1975. Conclusions The burden of pancreatic cancer is still very high in China, and attention should be paid to the key population that is, males and older people. The results of our study can be used by policy makers to allocate resources efficiently to improve early diagnosis and treatment, improving the awareness of self-protection, and advocating a healthy lifestyle to prevent pancreatic cancer.

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Inequalities and Impact of Socioeconomic-Cultural Factors in Suicide Rates Across Italy

Crisis ◽

10.1027/0227-5910/a000084 ◽

2011 ◽

Vol 32 (4) ◽

pp. 178-185 ◽

Cited By ~ 15

Author(s):

Maurizio Pompili ◽

Marco Innamorati ◽

Monica Vichi ◽

Maria Masocco ◽

Nicola Vanacore ◽

...

Keyword(s):

Suicide Rate ◽

Age Groups ◽

Premature Death ◽

Mortality Rates ◽

Mortality Data ◽

Italian Population ◽

Comprehensive Overview ◽

Suicide Rates ◽

Younger Age ◽

Age And Sex

Background: Suicide is a major cause of premature death in Italy and occurs at different rates in the various regions. Aims: The aim of the present study was to provide a comprehensive overview of suicide in the Italian population aged 15 years and older for the years 1980–2006. Methods: Mortality data were extracted from the Italian Mortality Database. Results: Mortality rates for suicide in Italy reached a peak in 1985 and declined thereafter. The different patterns observed by age and sex indicated that the decrease in the suicide rate in Italy was initially the result of declining rates in those aged 45+ while, from 1997 on, the decrease was attributable principally to a reduction in suicide rates among the younger age groups. It was found that socioeconomic factors underlined major differences in the suicide rate across regions. Conclusions: The present study confirmed that suicide is a multifaceted phenomenon that may be determined by an array of factors. Suicide prevention should, therefore, be targeted to identifiable high-risk sociocultural groups in each country.

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Urban Air Pollution May Enhance COVID-19 Case-Fatality and Mortality Rates in the United States

The Innovation ◽

10.1016/j.xinn.2020.100047 ◽

2020 ◽

Vol 1 (3) ◽

pp. 100047 ◽

Cited By ~ 7

Author(s):

Donghai Liang ◽

Liuhua Shi ◽

Jingxuan Zhao ◽

Pengfei Liu ◽

Jeremy A. Sarnat ◽

...

Keyword(s):

United States ◽

Air Pollution ◽

Urban Air Pollution ◽

Case Fatality ◽

The United States ◽

Mortality Rates ◽

Urban Air

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Outcomes for Children and Adolescents With Cancer: Challenges for the Twenty-First Century

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.0421 ◽

2010 ◽

Vol 28 (15) ◽

pp. 2625-2634 ◽

Cited By ~ 593

Author(s):

Malcolm A. Smith ◽

Nita L. Seibel ◽

Sean F. Altekruse ◽

Lynn A.G. Ries ◽

Danielle L. Melbert ◽

...

Keyword(s):

United States ◽

Childhood Cancer ◽

Cancer Mortality ◽

Lymphoblastic Leukemia ◽

The United States ◽

Mortality Rates ◽

Mortality Data ◽

Childhood Cancers ◽

Essential Information ◽

The Impact

Purpose This report provides an overview of current childhood cancer statistics to facilitate analysis of the impact of past research discoveries on outcome and provide essential information for prioritizing future research directions. Methods Incidence and survival data for childhood cancers came from the Surveillance, Epidemiology, and End Results 9 (SEER 9) registries, and mortality data were based on deaths in the United States that were reported by states to the Centers for Disease Control and Prevention by underlying cause. Results Childhood cancer incidence rates increased significantly from 1975 through 2006, with increasing rates for acute lymphoblastic leukemia being most notable. Childhood cancer mortality rates declined by more than 50% between 1975 and 2006. For leukemias and lymphomas, significantly decreasing mortality rates were observed throughout the 32-year period, though the rate of decline slowed somewhat after 1998. For remaining childhood cancers, significantly decreasing mortality rates were observed from 1975 to 1996, with stable rates from 1996 through 2006. Increased survival rates were observed for all categories of childhood cancers studied, with the extent and temporal pace of the increases varying by diagnosis. Conclusion When 1975 age-specific death rates for children are used as a baseline, approximately 38,000 childhood malignant cancer deaths were averted in the United States from 1975 through 2006 as a result of more effective treatments identified and applied during this period. Continued success in reducing childhood cancer mortality will require new treatment paradigms building on an increased understanding of the molecular processes that promote growth and survival of specific childhood cancers.

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Descriptive-epidemiological characteristics of lung cancer in Serbia

Medicinski pregled ◽

10.2298/mpns0802016m ◽

2008 ◽

Vol 61 (1-2) ◽

pp. 16-21 ◽

Cited By ~ 1

Author(s):

Natasa Maksimovic ◽

Kyriakos Spanopoulos

Keyword(s):

Lung Cancer ◽

Direct Method ◽

Age Groups ◽

Malignant Tumour ◽

Mortality Rates ◽

Malignant Tumours ◽

Mortality Trends ◽

Incidence And Mortality ◽

The Republic ◽

Epidemiological Characteristics

Introduction. Lung cancer represents the most common malignant tumour among men, and appears more and more frequently among women in many countries worldwide. The aims of this descriptive epidemiological study were to evaluate the mortality trends of all malignant tumours and lung cancer in Central Serbia from 1990 to 1999, and to estimate the incidence, mortality and the basic demographic characteristics of lung cancer in Central Serbia in 1999. Material and methods. The source of data concerning cancer cases in 1999 was the Cancer Registry of Central Serbia, while data of the Republic Statistics Institute were used for the analysis of mortality trends for the period 1990-1999. All rates were standardized by the direct method, to the world standard population. Confidence intervals for mortality rates were assessed with 95% level of probability. Linear regression coefficient was determined by Fisher's test. Results. The mortality rates showed rising tendencies for both lung cancer (y=-1876.26+0.96x, p=0.028 for men; y=654.78U).33x, p-0.001 for women) and all malignant tumours (y=-4139.88+2.15x, p=0.163 for men; y=3649.68 + 1.88x, p=0.016 for women), with statistically significant increase being observed for all trends, except all malignant tumours among men. In the year 1999, lung cancer ranked first among men and third among women, with 29.2% and 10.3% of cancer mortality respectively. The age-specific mortality rates were much higher in men in all age groups. Mortality increased with age and the highest rates were found in the age group 70-74 for both sexes. The highest incidence and mortality rates were reported in Belgrade, Moravicki and Sumadijski district. .

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Incidence and mortality rates of intracranial hemorrhage in hemophilia: a systematic review and meta-analysis

Blood ◽

10.1182/blood.2021011849 ◽

2021 ◽

Author(s):

Anne-Fleur Zwagemaker ◽

Samantha C Gouw ◽

Julie J Jansen ◽

Caroline Vuong ◽

Michiel Coppens ◽

...

Keyword(s):

Systematic Review ◽

Young Adults ◽

Intracranial Hemorrhage ◽

Meta Analysis ◽

Age Groups ◽

Mortality Rates ◽

Normal Model ◽

Live Births ◽

Incidence And Mortality ◽

Children And Young Adults

Intracranial hemorrhage (ICH) is a severe complication that is relatively common among hemophilia patients. This systematic review aimed to obtain more precise estimates of ICH incidence and mortality in hemophilia, which may be important for patients, caregivers, researchers and health policy-makers. PubMed and EMBASE were systematically searched using terms related to "hemophilia" and "intracranial hemorrhage" or "mortality". Studies that allowed calculation of ICH incidence or mortality rates in a hemophilia population of at least 50 patients were included. We summarized evidence on ICH incidence and calculated pooled ICH incidence and mortality in three age groups: (1) persons of all ages with hemophilia, (2) children and young adults below 25 years of age with hemophilia and (3) neonates with hemophilia. Incidence and mortality were pooled with a Poisson-Normal model or a Binomial-Normal model. We included 45 studies that represented 54 470 patients, 809 151 person-years and 5326 live births of hemophilia patients. In persons of all ages, the pooled ICH incidence and mortality rates were 2.3 (95% CI 1.2-4.8) and 0.8 (95% CI 0.5-1.2) per 1000 person-years, respectively. In children and young adults, the pooled ICH incidence and mortality rates were 7.4 (95% CI 4.9-11.1) and 0.5 (95% CI 0.3-0.9) per 1000 person-years, respectively. In neonates, the pooled cumulative ICH incidence was 2.1% (95% CI 1.5-2.8) per 100 live births. ICH was classified as spontaneous in 35-58% of cases. Our findings suggest that ICH is an important problem in hemophilia that occurs among all ages, requiring adequate preventive strategies.

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