Racial and Ethnic Disparities in Heart and Cerebrovascular Disease Deaths During the COVID-19 Pandemic in the United States

Background: Cardiovascular deaths increased during the early phase of the COVID-19 pandemic in the United States. However, it is unclear whether racial/ethnic minorities have experienced a disproportionate rise in heart disease and cerebrovascular disease deaths. Methods: We used the National Center for Health Statistics to identify heart disease and cerebrovascular disease deaths for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic individuals from March-August 2020 (pandemic period), as well as for the corresponding months in 2019 (historical control). We determined the age- and sex-standardized deaths per million by race/ethnicity for each year. We then fit a modified Poisson model with robust standard errors to compare change in deaths by race/ethnicity for each condition in 2020 vs. 2019. Results: There were a total of 339,076 heart disease and 76,767 cerebrovascular disease deaths from March through August 2020, compared to 321,218 and 72,190 deaths during the same months in 2019. Heart disease deaths increased during the pandemic in 2020, compared with the corresponding period in 2019, for non-Hispanic White (age-sex standardized deaths per million, 1234.2 vs. 1208.7; risk ratio for death [RR] 1.02, 95% CI 1.02-1.03), non-Hispanic Black (1783.7 vs. 1503.8; RR 1.19, 1.17-1.20), non-Hispanic Asian (685.7 vs. 577.4; RR 1.19, 1.15-1.22), and Hispanic (968.5 vs. 820.4, RR 1.18, 1.16-1.20) populations. Cerebrovascular disease deaths also increased for non-Hispanic White (268.7 vs. 258.2; RR 1.04, 95% CI 1.03-1.05), non-Hispanic Black (430.7 vs. 379.7; RR 1.13, 95% CI 1.10-1.17), non-Hispanic Asian (236.5 vs. 207.4; RR 1.15, 1.09-1.21), and Hispanic (264.4 vs. 235.9; RR 1.12, 1.08-1.16) populations. For both heart disease and cerebrovascular disease deaths, each racial and ethnic minority group experienced a larger relative increase in deaths than the non-Hispanic White population (interaction term, p<0.001). Conclusions: During the COVID-19 pandemic in the US, Black, Hispanic, and Asian populations experienced a disproportionate rise in deaths due to heart disease and cerebrovascular disease, suggesting that racial/ethnic minorities have been most impacted by the indirect effects of the pandemic. Public health and policy strategies are needed to mitigate the short- and long-term adverse effects of the pandemic on the cardiovascular health of minority populations.

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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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062921 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2921

Author(s):

Jay J. Xu ◽

Jarvis T. Chen ◽

Thomas R. Belin ◽

Ronald S. Brookmeyer ◽

Marc A. Suchard ◽

...

Keyword(s):

United States ◽

District Of Columbia ◽

Ethnic Disparities ◽

The United States ◽

Attributable Mortality ◽

Race Ethnicity ◽

Using Data ◽

Rate Ratios ◽

Degree Of Association ◽

Racial Ethnic

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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Infant Mortality among Adolescent Mothers in the United States: A 5-Year Analysis of Racial and Ethnic Disparities

American Journal of Perinatology ◽

10.1055/s-0040-1714678 ◽

2020 ◽

Author(s):

Matthew D. Moore ◽

Anne E. Brisendine ◽

Martha S. Wingate

Keyword(s):

United States ◽

Preterm Birth ◽

Infant Mortality ◽

Ethnic Disparities ◽

The United States ◽

Racial And Ethnic Disparities ◽

Postneonatal Mortality ◽

Maternal Characteristics ◽

Race Ethnicity ◽

Racial Ethnic

Objective This study was aimed to examine differences in infant mortality outcomes across maternal age subgroups less than 20 years in the United States with a specific focus on racial and ethnic disparities. Study Design Using National Center for Health Statistics cohort-linked live birth–infant death files (2009-2013) in this cross-sectional study, we calculated descriptive statistics by age (<15, 15–17, and 18–19 years) and racial/ethnic subgroups (non-Hispanic white [NHW], non-Hispanic black [NHB], and Hispanic) for infant, neonatal, and postneonatal mortality. Adjusted odds ratios (aOR) were calculated by race/ethnicity and age. Preterm birth and other maternal characteristics were included as covariates. Results Disparities were greatest for mothers <15 and NHB mothers. The risk of infant mortality among mothers <15 years compared to 18 to 19 years was higher regardless of race/ethnicity (NHW: aOR = 1.40, 95% confidence interval [CI]: 1.06–1.85; NHB: aOR = 1.28, 95% CI: 1.04–1.56; Hispanic: aOR = 1.36, 95%CI: 1.07–1.74). Compared to NHW mothers, NHB mothers had a consistently higher risk of infant mortality (15–17 years: aOR = 1.12, 95% CI: 1.03–1.21; 18–19 years: aOR = 1.21, 95% CI: 1.15–1.27), while Hispanic mothers had a consistently lower risk (15–17 years: aOR = 0.72, 95% CI: 0.66–0.78; 18–19 years: aOR = 0.74, 95% CI: 0.70–0.78). Adjusting for preterm birth had a greater influence than maternal characteristics on observed group differences in mortality. For neonatal and postneonatal mortality, patterns of disparities based on age and race/ethnicity differed from those of overall infant mortality. Conclusion Although infants born to younger mothers were at increased risk of mortality, variations by race/ethnicity and timing of death existed. When adjusted for preterm birth, differences in risk across age subgroups declined and, for some racial/ethnic groups, disappeared. Key Points

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Racial/Ethnic Disparities in Lost Earnings From Cancer Deaths in the United States

JNCI Cancer Spectrum ◽

10.1093/jncics/pkaa038 ◽

2020 ◽

Vol 4 (5) ◽

Cited By ~ 1

Author(s):

Jingxuan Zhao ◽

Kimberly D Miller ◽

Farhad Islami ◽

Zhiyuan Zheng ◽

Xuesong Han ◽

...

Keyword(s):

United States ◽

Economic Burden ◽

Ethnic Disparities ◽

The United States ◽

Pacific Islanders ◽

Equal Access ◽

Years Of Life Lost ◽

Cancer Death ◽

Race Ethnicity ◽

Racial Ethnic

Abstract Background Little is known about disparities in economic burden due to premature cancer deaths by race or ethnicity in the United States. This study aimed to compare person-years of life lost (PYLLs) and lost earnings due to premature cancer deaths by race/ethnicity. Methods PYLLs were calculated using recent national cancer death and life expectancy data. PYLLs were combined with annual median earnings to generate lost earnings. We compared PYLLs and lost earnings among individuals who died at age 16-84 years due to cancer by racial/ethnic groups (non-Hispanic [NH] White, NH Black, NH Asian or Pacific Islander, and Hispanic). Results In 2015, PYLLs due to all premature cancer deaths were 6 512 810 for NH Whites, 1 196 709 for NH Blacks, 279 721 for NH Asian or Pacific Islanders, and 665 968 for Hispanics, translating to age-standardized lost earning rates (per 100 000 person-years) of $34.9 million, $43.5 million, $22.2 million, and $24.5 million, respectively. NH Blacks had higher age-standardized PYLL and lost earning rates than NH Whites for 13 of 19 selected cancer sites. If age-specific PYLL and lost earning rates for NH Blacks were the same as those of NH Whites, 241 334 PYLLs and $3.2 billion lost earnings (22.6% of the total lost earnings among NH Blacks) would have been avoided. Disparities were also observed for average PYLLs and lost earnings per cancer death for all cancers combined and 18 of 19 cancer sites. Conclusions Improving equal access to effective cancer prevention, screening, and treatment will be important in reducing the disproportional economic burden associated with racial/ethnic disparities.

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Differential Association of HIV Funding With HIV Mortality by Race/Ethnicity, United States, 1999-2017

Public Health Reports ◽

10.1177/0033354920912716 ◽

2020 ◽

Vol 135 (1_suppl) ◽

pp. 149S-157S

Author(s):

Benedict I. Truman ◽

Ramal Moonesinghe ◽

Yolanda T. Brown ◽

Man-Huei Chang ◽

Jonathan H. Mermin ◽

...

Keyword(s):

United States ◽

The United States ◽

Rate Of Change ◽

Fiscal Year ◽

Death Rates ◽

Black Residents ◽

Race Ethnicity ◽

Hiv Funding ◽

Racial Ethnic ◽

Hispanic White

Objective Federal funds have been spent to reduce the disproportionate effects of HIV/AIDS on racial/ethnic minority groups in the United States. We investigated the association between federal domestic HIV funding and age-adjusted HIV death rates by race/ethnicity in the United States during 1999-2017. Methods We analyzed HIV funding data from the Kaiser Family Foundation by federal fiscal year (FFY) and US age-adjusted death rates (AADRs) by race/ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, and Asian/Pacific Islander and American Indian/Alaska Native [API+AI/AN]) from Centers for Disease Control and Prevention WONDER detailed mortality files. We fit joinpoint regression models to estimate the annual percentage change (APC), average APC, and changes in AADRs per billion US dollars in HIV funding, with 95% confidence intervals (CIs). For 19 data points, the number of joinpoints ranged from 0 to 4 on the basis of rules set by the program or by the user. A Monte Carlo permutation test indicated significant ( P < .05) changes at joinpoints, and 2-sided t tests indicated significant APCs in AADRs. Results Domestic HIV funding increased from $10.7 billion in FFY 1999 to $26.3 billion in FFY 2017, but AADRs decreased at different rates for each racial/ethnic group. The average rate of change in AADR per US billion dollars was −9.4% (95% CI, −10.9% to −7.8%) for Hispanic residents, −7.8% (95% CI, −9.0% to −6.6%) for non-Hispanic black residents, −6.7% (95% CI, −9.3% to −4.0%) for non-Hispanic white residents, and −5.2% (95% CI, −7.8% to −2.5%) for non-Hispanic API+AI/AN residents. Conclusions Increased domestic HIV funding was associated with faster decreases in age-adjusted HIV death rates for Hispanic and non-Hispanic black residents than for residents in other racial/ethnic groups. Increasing US HIV funding could be associated with decreasing future racial/ethnic disparities in the rate of HIV-related deaths.

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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

10.1101/2021.01.28.21249411 ◽

2021 ◽

Author(s):

Jay J. Xu ◽

Jarvis T. Chen ◽

Thomas R. Belin ◽

Ronald S. Brookmeyer ◽

Marc A. Suchard ◽

...

Keyword(s):

United States ◽

District Of Columbia ◽

Ethnic Disparities ◽

The United States ◽

Attributable Mortality ◽

Estimation Uncertainty ◽

Race Ethnicity ◽

Using Data ◽

Rate Ratios ◽

Racial Ethnic

AbstractThe 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 December 30, 2020. Using a novel Monte Carlo simulation procedure to quantify estimation uncertainty, 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, observed 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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National Population-Level Disparities in COVID-19 Mortality Across the Intersection of Race/Ethnicity and Sex in the United States

10.1101/2021.08.29.21262775 ◽

2021 ◽

Author(s):

Jay J Xu ◽

Jarvis T Chen ◽

Thomas R Belin ◽

Ronald S Brookmeyer ◽

Marc A Suchard ◽

...

Keyword(s):

United States ◽

American Indian ◽

Ethnic Disparities ◽

Population Level ◽

The United States ◽

Mortality Rates ◽

Hispanic American ◽

National Population ◽

Race Ethnicity ◽

Racial Ethnic

Males and certain racial/ethnic minority groups have borne a disproportionate burden of COVID-19 mortality in the United States, and substantial scientific research has sought to quantify and characterize population-level disparities in COVID-19 mortality outcomes by sex and across categories of race/ethnicity. However, there has not yet been a national population-level study to quantify disparities in COVID-19 mortality outcomes across the intersection of these demographic dimensions. Here, we analyze a publicly available dataset from the National Center for Health Statistics comprising COVID-19 death counts stratified by race/ethnicity, sex, and age for the year 2020, calculating mortality rates for each race/ethnicity-sex-age stratum and age-adjusted mortality rates for each race/ethnicity-sex stratum, quantifying disparities in terms of mortality rate ratios and rate differences. Our results reveal persistently higher COVID-19 age-adjusted mortality rates for males compared to females within every racial/ethnic group, with notable variation in the magnitudes of the sex disparity by race/ethnicity. However, non-Hispanic Black, Hispanic, and non-Hispanic American Indian or Alaska Native females have higher age-adjusted mortality rates than non-Hispanic White and non-Hispanic Asian/Pacific Islander males. Moreover, persistent racial/ethnic disparities are observed among both males and females, with higher COVID-19 age-adjusted mortality rates observed for non-Hispanic Blacks, Hispanics, and non-Hispanic American Indian or Alaska Natives relative to non-Hispanic Whites.

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The Association Between Educational Attainment and Diabetes Among Men in the United States

American Journal of Men s Health ◽

10.1177/1557988313520034 ◽

2014 ◽

Vol 8 (4) ◽

pp. 349-356 ◽

Cited By ~ 6

Author(s):

Shanta M. Whitaker ◽

Janice V. Bowie ◽

Rachael McCleary ◽

Darrell J. Gaskin ◽

Thomas A. LaVeist ◽

...

Keyword(s):

United States ◽

Educational Attainment ◽

The United States ◽

Bachelor's Degree ◽

Logistic Regression Models ◽

Hispanic Men ◽

Race Ethnicity ◽

The Relationship ◽

Racial Ethnic ◽

Hispanic White

Few studies have examined the relationship between education and diabetes among men in the United States and whether this relationship differs by race/ethnicity. This study examined whether racial disparities in diabetes existed by educational attainment in 336,746 non-Hispanic White, non-Hispanic Black, and Hispanic men 18 years of age and older in the United States. Logistic regression models were specified to examine the odds of reporting diabetes by educational attainment. Within race/ethnicity, both White and Hispanic men who had less than a high school education (odds ratio [OR] = 1.42, 95% confidence interval [CI] = [1.19, 1.69], and OR = 1.64, 95% CI = [1.22, 2.21], respectively) had consistently higher odds of diabetes than men with a bachelor’s degree or higher level of educational attainment. Educational attainment did not appear to be associated with reporting a diagnosis of diabetes in non-Hispanic Black men. Identifying why educational attainment is associated with diabetes outcomes in some racial/ethnic groups but not others is essential for diabetes treatment and management.

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Racial/Ethnic Disparities in Hypertension Prevalence, Awareness, Treatment, and Control in the United States, 2013 to 2018

Hypertension ◽

10.1161/hypertensionaha.121.17570 ◽

2021 ◽

Author(s):

Rahul Aggarwal ◽

Nicholas Chiu ◽

Rishi K. Wadhera ◽

Andrew E. Moran ◽

Inbar Raber ◽

...

Keyword(s):

United States ◽

Ethnic Disparities ◽

The United States ◽

Self Report ◽

Similar Treatment ◽

Hypertension Prevalence ◽

Health And Nutrition ◽

Race Ethnicity ◽

And Control ◽

White Adults

We evaluated the prevalence, awareness, treatment, and control of hypertension (defined as a systolic blood pressure [BP]) ≥140 mm Hg, diastolic BP ≥90 mm Hg, or a self-reported use of an antihypertensive agent) among US adults, stratified by race/ethnicity. This analysis included 16 531 nonpregnant US adults (≥18 years) in the three National Health and Nutrition Examination Survey cycles between 2013 and 2018. Race/ethnicity was defined by self-report as White, Black, Hispanic, Asian, or other Americans. Among 76 910 050 (74 449 985–79 370 115) US adults with hypertension, 48.6% (47.3%–49.8%, unadjusted) have controlled BP. When compared with BP control rates for White adults (49.0% [46.8%–51.2%], age-adjusted), BP control rates are lower in Black (39.2%, adjusted odds ratio [aOR], 0.71 [95% CI, 0.59–0.85], P <0.001), Hispanic (40.0%, aOR, 0.71 [95% CI, 0.58–0.88], P =0.003), and Asian (37.8%, aOR, 0.68 [95% CI, 0.55–0.84], P =0.001) Americans. Black adults have higher hypertension prevalence (45.3% versus 31.4%, aOR, 2.24 [95% CI, 1.97–2.56], P <0.001) but similar awareness and treatment rates as White adults. Hispanic adults have similar hypertension prevalence, but lower awareness (71.1% versus 79.1%, aOR, 0.72 [95% CI, 0.58–0.89], P =0.005) and treatment rates (60.5% versus 67.3%, aOR, 0.78 [95% CI, 0.66–0.94], P =0.010) than White adults. Asian adults have similar hypertension prevalence, lower awareness (72.5% versus 79.1%, aOR, 0.75 [95% CI, 0.58–0.97], P =0.038) but similar treatment rates. Black, Hispanic, and Asian Americans have different vulnerabilities in the hypertension control cascade of prevalence, awareness, treatment, and control. These differences can inform targeted public health efforts to promote health equity and reduce the burden of hypertension in the United States.

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