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Coronavirus death toll over twice as high among people of color below 65 than for white Americans: CDC

More than a third of deaths among Hispanic Americans (34.9%) and almost a third of deaths among non-White Americans (29.5%) were in people younger than 65
(Getty Images)
(Getty Images)

The Covid-19 pandemic has proved to be deadlier for people of color under the age of 65, with Hispanic and non-White Americans experiencing significantly higher death toll as compared to White people, according to a new analysis by the US Centers for Disease Control and Prevention (CDC).

Researchers found that among people younger than 65 who died from Covid-19, about 34.9% were Hispanic and 29.5% were non-White. This is more than twice that of White Americans: 13.2% of deaths among White people were in those younger than 65. This stark difference was ‘notable,’ said the authors, who analyzed supplementary data for 10,647 deaths in 16 public health jurisdictions. The deaths had occurred during February 12-April 24, 2020.

“Using national case-based surveillance and supplementary data reported from 16 jurisdictions, characteristics of over 10,000 decedents with laboratory-confirmed Covid-19 were described. More than one-third of Hispanic decedents (34.9%) and nearly one third (29.5%) of nonwhite decedents were aged below 65 years, but only 13.2% of white decedents were aged below 65 years. The percentages of Hispanic and non-White decedents who were aged below 65 years were more than twice those of white decedents. The relatively high percentages of Hispanic and nonwhite decedents aged less than 65 years were notable,” says the analysis. 

Among the 10,647 deaths, 60.6% were male, 74.8% were 65 years or older, 24.4% were Hispanic, 24.9% were Black, 35% were White, and 6.3% were Asian, 0.1% were American Indian or Alaskan natives, 0.1% were Native Hawaiian or other Pacific Islander, 2.9% were multiracial or other race, and race/ethnicity was unknown for 6.3%. Among those who died, 9,997 (93.9%) were from New York City, New Jersey, or the state of Washington, three areas with early widespread circulation of Covid-19, the median age being 75 years.

According to the analysis, non-White Americans (median age 31) are younger as a whole than White Americans (median age 44), but Covid-19 deaths among those under age 65 exceeded their proportion of the population. Researchers found that while 33.9% of people under 65 who died were Hispanic, they account for just 20% of the under-65 population in the US. Similarly, Black, Asian, and other non-White people accounted for 40.2% of deaths under 65, though they make up just 23% of those under 65 in the US. Black Americans accounted for 30% of deaths under age 65; Asian people and multiracial people accounted for 6.1% and 4.1%,  respectively. White people accounted for 18.4% of the deaths among those below 65. 

Clinical features of patients who died from Covid-19 in the US from February 12-April 24. (CDC)

“The median ages among Hispanic and nonwhite decedents (71 and 72 years, respectively) were 9-10 years lower than that of white decedents (81 years). However, the percentage of Hispanic decedents aged below 65 years (33.9%) exceeded the percentage of Hispanic persons aged below 65 years in the US. population (20%). The percentage of non-White Covid-19 decedents aged less than 65 years (40.2%) also exceeded the overall percentage of nonwhite decedents aged below 65 years (23%) in the US population,” the findings state.

According to the authors, further study is needed to understand the reasons for these differences. They say it is possible that rates of Covid-19 transmission are higher among Hispanic and non-White persons below 65 years than among White persons, and one potential contributing factor is higher percentages of Hispanic and non-White persons engaged in occupations (such as service industry) or essential activities that preclude physical distancing. “It is also possible that the Covid-19 pandemic disproportionately affected communities of younger, non-White persons during the study period. Although these data did not permit assessment of interactions between race/ethnicity, underlying medical conditions, and non-biologic factors, further studies to understand and address these racial/ethnic differences are needed to inform targeted efforts to prevent Covid-19 mortality,” say experts.

Consistent with previous reports, the analysis also shows most people (approximately three fourths) who died had underlying medical conditions. At least one underlying medical condition was reported for 8,134 (76.4%) of those who died and for whom sup­plementary data were collected, including 83.1% aged less than 65 years. Overall, the most common underlying medical conditions were cardiovascular disease (60.9%), diabetes mellitus (39.5%), chronic kidney disease (20.8%), and chronic lung disease (19.2%). Among people below 65 who died, 83.1% had one or more underlying medical conditions, and this number was 69.5% for those 85 years and above. Diabetes was more common underlying condition among people younger than 65 who died (49.6%) than among those aged 85 years and above (25.9%).

The analysis also shows that approximately three fourths who died from Covid-19 had underlying medical conditions (Getty Images)

Among those who died, 62% died in hospitals. By age group, the largest percentage who died in the emergency department (6.8%) or at home (1.0%) was younger than 65 years (combined total of 7.8%) and decreased with increasing age group. The percentage who died in long-term care facilities increased with increasing age and was highest among those 85 years and older (12.6%). “Among decedents aged less than 65 years, 7.8% died in an emergency department or at home. These out-of-hospital deaths might reflect lack of healthcare access, delays in seeking care, or diagnostic delays,” write authors. 

The team says additional studies are needed to explain associations between age, race/ethnicity, Covid-19 infection, disease severity, underlying medical conditions (especially diabetes), socioeconomic status (poverty and access to healthcare), behavioral factors (ability to comply with mitigation recommendations and maintain essential work responsibilities), and out-of-hospital deaths. Regional and state-level efforts to examine the roles of these factors in Covid-19 transmission and Covid-19-associated deaths could lead to targeted, community-level, mortality prevention initiatives, they explain. 

The experts recommend health communications campaigns to encourage patients, particularly those with underlying medical conditions, to seek medical care earlier in their illnesses. “Examples include health communication campaigns targeted towards Hispanics and non-White persons aged below 65 years. These campaigns could encourage social distancing and the need for wearing cloth face coverings in public settings. Additionally, healthcare providers should be encouraged to consider the possibility of severe disease among younger persons who are Hispanic, non-White, or have underlying medical conditions. More prompt diagnoses could facilitate earlier implementation of supportive care to minimize morbidity among individuals and earlier isolation of contagious persons to protect communities from Covid-19 transmission,” say researchers.