Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Center for Social Epidemiology and Public Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Clin Infect Dis. 2021 Mar 1;72(5):e88-e95. doi: 10.1093/cid/ciaa1723.
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.
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.
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.
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.
截至 2020 年 11 月 1 日，美国因严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）导致的死亡人数超过 23 万，确诊和可能病例数达到 900 万。然而，这场压倒性的灾难并非平均分布，地理、种族/族裔、年龄和社会经济方面的差异在接触和死亡率方面定义了美国 2019 年冠状病毒病（COVID-19）流行的特征。
我们使用密歇根州的 COVID-19 发病率和死亡率的个体水平数据，按种族/族裔群体估计特定年龄的发病率和死亡率。使用分层贝叶斯回归模型分析数据，并使用后验预测检查验证模型结果。
在粗发病率和年龄标准化分析中，我们发现所有群体的发病率和死亡率都比白人高两倍以上，除了美洲原住民。黑人经历了确诊和可能的 COVID-19 （年龄标准化发病率，1626/100000 人）和死亡率（年龄标准化死亡率，244/100000 人）最大的负担。这些比率反映了巨大的差异，因为黑人经历的年龄标准化发病率和死亡率分别是白人的 5.5 倍（95%后验可信区间[CrI]，5.4-5.6）和 6.7 倍（95% CrI，6.4-7.1）。我们发现，黑人与白人之间死亡率的大部分差异是由所有年龄段 COVID-19 感染率的急剧升高驱动的，尤其是在老年人中，而不是特定年龄的病死率的变化。
这项工作表明，在密歇根州等受灾严重地区，COVID-19 死亡率的有据可查的种族差异主要是由家庭、社区和工作场所暴露的差异而不是病死率的差异所驱动的。
