Am J Epidemiol. 2024 Jun 3;193(6):853-862. doi: 10.1093/aje/kwae007.
Prior research on racial/ethnic disparities in COVID-19 mortality has often not considered to what extent they reflect COVID-19-specific factors, versus preexisting health differences. This study examines how racial/ethnic disparities in COVID-19 mortality vary with age, sex, and time period over April-December 2020 in the United States, using mortality from other natural causes as a proxy for underlying health. We study a novel measure, the COVID excess mortality percentage (CEMP), defined as the COVID-19 mortality rate divided by the non-COVID natural mortality rate, converted to a percentage, where the CEMP denominator controls (albeit imperfectly) for differences in population health. Disparities measured using CEMP deviate substantially from those in prior research. In particular, we find very high disparities (up to 12:1) in CEMP rates for Hispanics versus Whites, particularly for nonelderly men. Asians also have elevated CEMP rates versus Whites, which were obscured in prior work by lower overall Asian mortality. Native Americans and Blacks have significant disparities compared with White populations, but CEMP ratios to Whites are lower than ratios reported in other work. This is because the higher COVID-19 mortality for Blacks and Native Americans comes partly from higher general mortality risk and partly from COVID-specific risk.
先前关于 COVID-19 死亡率中种族/民族差异的研究往往没有考虑到这些差异在多大程度上反映了 COVID-19 特有的因素，而不是预先存在的健康差异。本研究使用其他自然原因导致的死亡率作为潜在健康状况的替代指标，考察了 2020 年 4 月至 12 月期间，美国 COVID-19 死亡率随年龄、性别和时间的变化情况。我们研究了一个新的指标，即 COVID 超额死亡率百分比（CEMP），它定义为 COVID-19 死亡率除以非 COVID 自然死亡率，转换为百分比，其中 CEMP 分母控制（尽管不完美）人口健康的差异。使用 CEMP 衡量的差异与先前研究中的差异有很大不同。特别是，我们发现西班牙裔与白人之间的 CEMP 率差异非常大（高达 12:1），尤其是在非老年男性中。与白人相比，亚洲人的 CEMP 率也较高，但在先前的研究中被整体较低的亚洲死亡率所掩盖。与白人相比，美国原住民和黑人的死亡率存在显著差异，但与其他研究报告的比值相比，CEMP 比值较低，这是因为黑人和美国原住民的 COVID-19 死亡率较高部分是由于一般死亡率风险较高，部分是由于 COVID-19 特定风险较高。
