Race, Ethnicity, and Age Trends in Persons Who Died From COVID-19

United States, May-August 2020

Jeremy A.W. Gold, MD; Lauren M. Rossen, PhD; Farida B. Ahmad, MPH; Paul Sutton, PhD; Zeyu Li, MPH; Phillip P. Salvatore, PhD; Jayme P. Coyle, PhD; Jennifer DeCuir, MD, PhD; Brittney N. Baack, MPH; Tonji M. Durant, PhD; Kenneth L. Dominguez, MD; S. Jane Henley, MSPH; Francis B. Annor, PhD; Jennifer Fuld, PhD; Deborah L. Dee, PhD; Achuyt Bhattarai, MD; Brendan R. Jackson, MD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(42):1517-1521. 

In This Article

Abstract and Introduction

Introduction

During February 12–October 15, 2020, the coronavirus disease 2019 (COVID-19) pandemic resulted in approximately 7,900,000 aggregated reported cases and approximately 216,000 deaths in the United States.* Among COVID-19–associated deaths reported to national case surveillance during February 12–May 18, persons aged ≥65 years and members of racial and ethnic minority groups were disproportionately represented.[1] This report describes demographic and geographic trends in COVID-19–associated deaths reported to the National Vital Statistics System (NVSS) during May 1–August 31, 2020, by 50 states and the District of Columbia. During this period, 114,411 COVID-19–associated deaths were reported. Overall, 78.2% of decedents were aged ≥65 years, and 53.3% were male; 51.3% were non-Hispanic White (White), 24.2% were Hispanic or Latino (Hispanic), and 18.7% were non-Hispanic Black (Black). The number of COVID-19–associated deaths decreased from 37,940 in May to 17,718 in June; subsequently, counts increased to 30,401 in July and declined to 28,352 in August. From May to August, the percentage distribution of COVID-19–associated deaths by U.S. Census region increased from 23.4% to 62.7% in the South and from 10.6% to 21.4% in the West. Over the same period, the percentage distribution of decedents who were Hispanic increased from 16.3% to 26.4%. COVID-19 remains a major public health threat regardless of age or race and ethnicity. Deaths continued to occur disproportionately among older persons and certain racial and ethnic minorities, particularly among Hispanic persons. These results can inform public health messaging and mitigation efforts focused on prevention and early detection of infection among disproportionately affected groups.

In NVSS data, confirmed or presumed COVID-19–associated deaths are assigned the International Classification of Diseases, Tenth Revision code U07.1 as a contributing or underlying cause of death on the death certificate. The underlying cause of death is the condition that began the chain of events ultimately leading to the person's death. COVID-19 was the underlying cause for approximately 92% of COVID-19–associated deaths and was a contributing cause for approximately 8% during the investigation period.[2] NVSS data in this report exclude deaths among residents of territories and foreign countries.

Using NVSS data from May 1 through August 31, 2020, CDC tabulated the numbers and percentages of COVID-19–associated deaths by age, sex, race and ethnicity (categorized as Hispanic, White, Black, non-Hispanic Asian [Asian], non-Hispanic American Indian or Alaska Native [AI/AN], non-Hispanic Native Hawaiian or other Pacific Islander [NHPI], non-Hispanic multiracial [multiracial], and unknown), U.S. Census region,§ and location of death (e.g., hospital, nursing home or long-term care facility, or residence). Because only 0.5% of COVID-19 decedents were either NHPI or multiracial, and counts <10 are suppressed in NVSS to maintain confidentiality, these groups were combined into one group for analyses. Age, race and ethnicity, and place of death were unknown for two (<0.01%), 465 (0.4%), and 46 (0.04%) deaths, respectively. To describe changes in demographic features over time, percentages of deaths among two age groups (≥65 years and <65 years), racial and ethnic groups, and U.S. Census region were calculated for each month. R statistical software (version 3.6.3; The R Foundation) was used to tabulate death counts and generate histograms. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.

During May 1–August 31, 2020, a total of 114,411 COVID-19–associated deaths were reported to NVSS (Table). The number of COVID-19–associated deaths decreased from 37,940 in May to 17,718 in June; subsequently, counts increased to 30,401 in July and declined to 28,352 in August. Among decedents, the majority were male (53.3%), White (51.3%), aged ≥65 years (78.2%), and died in an inpatient health care setting (64.3%). Overall, 24.2% of decedents were Hispanic, 18.7% were Black, 3.5% were Asian, 1.3% were AI/AN, and 0.5% were either NHPI or multiracial. During the period studied, the largest percentage of COVID-19–associated deaths occurred in the South Census region (45.7%), followed by the Northeast (20.5%), the West (18.3%), and the Midwest (15.5%). Twenty-two percent of decedents died in a nursing home or long-term care facility.

During May–August 2020, the percentage of COVID-19–associated deaths occurring in the South increased from 23.4% in May to 62.7% in August, and in the West from 10.6% to 21.4%; the percentages occurring in the Northeast decreased from 44.2% in May to 4.0% in August, and in the Midwest declined from 21.8% to 11.8% (Figure 1). The percentage of decedents aged ≥65 years decreased from 81.8% to 77.6%, and the percentage of deaths occurring in nursing homes or long-term care facilities decreased from 29.8% to 16.6% (Figure 1).

Figure 1.

Monthly COVID-19–associated deaths* as a percentage of all deaths, by U.S. Census region, all ages (A), and for persons aged ≥65 years or persons of any age who died in a nursing home or long-term care facility (B) (N = 114,411) — National Vital Statistics System, United States, May 1–August 31, 2020
Abbreviation: COVID-19 = coronavirus disease 2019.
*Age data were missing for two (<0.01%) COVID-19 deaths, and place of death data were missing for 46 (0.04%) deaths. Total numbers of deaths might vary because of suppression of counts with <10 deaths.

From May to August, the percentage of decedents who were White decreased from 56.9% to 51.5%, and the percentage who were Black decreased from 20.3% to 17.4%, whereas the percentage who were Hispanic increased from 16.3% to 26.4% (Figure 2). Hispanics were the only racial and ethnic group among whom the overall percentage of deaths increased. Among persons aged ≥65 years, the monthly percentage of Hispanic decedents increased in the South (from 10.3% to 21.7%) and West (from 29.6% to 35.4%) and decreased in the Northeast (from 11.3% to 9.3%) and Midwest (from 7.8% to 4.2%). The monthly percentage of Hispanic decedents aged <65 years increased in the South (from 29.2% to 38.1%) and West (from 51.8% to 62.3%) and decreased in the Northeast (from 34.9% to 30.7%) and Midwest (31.1% to 20.4%) (Supplementary Figure, https://stacks.cdc.gov/view/cdc/95229).

Figure 2.

Monthly deaths, by race/ethnicity* as a percentage of all COVID-19–associated deaths (N = 114,411) — National Vital Statistics System, United States, May 1–August 31, 2020
Abbreviations: AI/AN = American Indian or Alaska Native; COVID-19 = coronavirus disease 2019; NH = non-Hispanic; NHPI = Native Hawaiian or other Pacific Islander.
*Race or ethnicity data were unknown for 465 (0.4%) deaths. Total numbers of deaths might vary because of suppression of counts with <10 deaths.

*CDC official counts of cases and deaths, released daily at https://covid.cdc.gov/covid-data-tracker/, are aggregate counts from reporting jurisdictions. Throughout the COVID-19 pandemic, and separately from the NVSS, CDC has been tracking both aggregate and individual (i.e., line-listed) counts of cases and deaths. For aggregate counts, from January 22 to March 2, 2020, CDC provided laboratory confirmation for all U.S. confirmed cases. Starting March 3, jurisdiction partners validated aggregate counts each night for report released at 12 p.m. the following day by CDC. For individual counts, jurisdiction partners electronically submit standardized information for individual cases of COVID-19 to CDC. From April 14, aggregate and individual counts included confirmed and probable cases and deaths, according to the Council of State and Territorial Epidemiologists (CSTE) position statement Interim 20-ID-01 (https://cdn.ymaws.com/www.cste.org/resource/resmgr/2020ps/interim-20-id-01_covid-19.pdf; https://wwwn.cdc.gov/nndss/conditions/coronavirus-disease-2019-covid-19/case-definition/2020/). On August 5, CSTE published an updated position statement, Interim 20-ID-02, to clarify the interpretation of antigen detection tests and serologic test results within the case classification (https://wwwn.cdc.gov/nndss/conditions/coronavirus-disease-2019-covid-19/case-definition/2020/08/05/).
https://www.cdc.gov/nchs/nvss/deaths.htm.
§U.S. Census Bureau regions are Northeast, Midwest, South, and West. https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf.
See e.g., 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq.

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