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COVID-19 Killing Disproportionate
Number of Younger Nonwhites in US
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Mark Mascolini
Almost one third of US nonwhites who die with COVID-19 are younger than 65, more than twice the proportion in whites, according to analysis of over 10,000 deaths in 15 US states and New York City [1]. More than one third of US Hispanics who die with coronavirus infection have not reached their 65th birthday. In contrast, only 13% of US whites who die with COVID-19 are under 65 years old.
From January 1 to May 18, 2020, local officials reported 1.3 million confirmed cases of COVID-19 and 83,000 COVID-19 deaths to the Centers for Disease Control and Prevention (CDC). Many US localities notice an undue burden of COVID-19 infection and death among racial and ethnic minorities. To learn more about characteristics of US residents who die with COVID-19, the CDC and regional public health workers analyzed data from the entire United States and from a subset of jurisdictions that supplied supplementary data.
In the overall February 12-May 18 analysis involving 52,166 deaths in 47 jurisdictions, 55.4% of people who died were men and 79.6% were 65 or older. Median age of people who died was 78 (interquartile range [IQR] 67 to 87). Proportions of people who died by race/ethnicity were 40.3% white, 21.0% black, 13.8% Hispanic, and 3.9% Asian. Blacks and Hispanics make up and 13.4% and 18.5% of the US population respectively, according to the US Census Bureau [2].
Fifteen states and New York City provided more complete data for analysis of 10,647 COVID-19 deaths. Men made up 60.6% of this group, whites 35.0%, blacks 24.9%, Hispanics 24.4%, Asians 6.3%, and the rest were mixed race or Native Americans. White people who died had a much older median age (81, IQR 71 to 88) than nonwhite non-Hispanics (72, IQR 62 to 81) or Hispanics (71, IQR 59 to 81). The proportion of people who died under age 65 was more than twice higher for Hispanics (34.9%) and nonwhite non-Hispanics (29.5%) than for whites (13.2%).
More than three quarters of people who died (76.4%) had at least one underlying condition, including 83.1% under 65 years old. The most frequent underlying conditions were cardiovascular disease (60.9%), diabetes (39.5%), chronic kidney disease (20.8%), and chronic lung disease (19.2%). Among people who died before age 65, the proportion with diabetes (49.6%) was much higher than in another analysis of COVID-19 patients admitted to the hospital before age 65 (35%) or people in the general population under age 65 (below 20%).
Among people who died and had complete data, 84.3% got admitted to the hospital and 62% died in the hospital. Median time from illness onset to death stood at 10 days (IQR 6 to 15) and median time from hospital admission to death at 5 days (IQR 3 to 8).
The researchers suggest that the higher proportion of COVID-19 deaths in Hispanics and other nonwhites than in whites could partly reflect the younger overall median age of US nonwhites (31 years) than US whites (44 years). They add that the percentage of Hispanics who died with COVID-19 before age 65 (34.9%) was much higher than the proportion of Hispanics under 65 in the general population (20%).
The authors speculate that higher COVID-19 death rates in US nonwhites under age 65 in this study could reflect greater SARS-CoV-2 transmission to younger nonwhites, perhaps partly because higher percentages of nonwhites hold jobs that preclude physical distancing.
Together these findings indicate a need for "targeted, community-level, mortality prevention initiatives," the researchers propose. Those initiatives could include health communication campaigns aimed at nonwhites younger than 65. Such campaigns could promote social distancing and wearing masks. The authors suggest providers should consider the possibility of faster COVID-19 progression in nonwhites, especially those with diabetes.
References
1. Wortham JM, Lee JT, Althomsons S, et al. Characteristics of persons who died with COVID-19-United States, February 12–May 18, 2020. MMWR Morb Mortal Wkly Rep 2020;69:923-929. DOI: http://dx.doi.org/10.15585/mmwr.mm6928e1.
2. United States Census Bureau. Quick Facts. https://www.census.gov/quickfacts/fact/table/US/RHI725219#RHI725219
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