Racial and Ethnic Disparities in COVID-19 Incidence by Age, Sex, and Period Among Persons Aged <25 Years

16 U.S. Jurisdictions, January 1-December 31, 2020

Miriam E. Van Dyke, PhD; Maria C.B. Mendoza, PhD; Wen Li, PhD; Erin M. Parker, PhD; Brook Belay, MD; Elizabeth M. Davis, MA; Joshua J. Quint, PhD; Ana Penman-Aguilar, PhD; Kristie E.N. Clarke, MD


Morbidity and Mortality Weekly Report. 2021;70(11):382-388. 

In This Article


Analysis of CDC's case-based surveillance data in 16 U.S. jurisdictions during January–December 2020 indicates that racial and ethnic differences in COVID-19 incidence among persons aged <25 years changed over time. Disparities were substantial early in the pandemic among most racial and ethnic minority groups compared with White persons and then decreased over time, largely because of a greater increase in incidence among White persons. Among NH/PI persons, disparities increased from January–April to May–August and then decreased by September–December. The largest persistent disparities in COVID-19 incidence were among NH/PI, AI/AN, and Hispanic persons. Other studies have reported disproportionately higher percentages of COVID-19 cases among Hispanic, Black, Asian, and AI/AN children;[4,5] however, no published studies to date have described national COVID-19 incidence among NH/PI children.

Social determinants of health influence racial and ethnic disparities in case incidence.§§§ The large racial and ethnic COVID-19 disparities identified early in the pandemic in this analysis might reflect differential ability to participate in early mitigation measures, such as stay-at-home orders.[6] Racial and ethnic minority groups are disproportionately represented in essential work settings, making it difficult for youths and parents to stay at home; a higher likelihood of living in a multigenerational household also increases the risk for household exposures to SARS-CoV-2.¶¶¶ For example, NH/PI persons, a group with some of the largest persistent disparities in this analysis, most often reside in multigenerational homes compared with other racial and ethnic groups.[7] Despite on average having lower income and educational attainment, NH/PI persons are often grouped in analyses with Asian persons,[8] thereby obscuring disparities influenced by these social determinants of health.

The decrease in racial and ethnic disparities observed over time was largely driven by a greater increase in COVID-19 incidence among White persons, rather than a decrease among racial and ethnic minority groups. This narrowing in differences should be considered in the context of geographic aspects of community spread over time and potential changes in access to or participation in mitigation measures or testing over time by race and ethnicity. For example, future studies could consider whether variations in state-mandated mitigation policies and other aspects of the policy environment led to the observed differential adherence in some mitigation measures by race/ethnicity.[9] Further study of whether some testing strategies (e.g., repeat testing of students in some academic settings****) might have been differentially available by race and ethnicity over time is also needed.

The findings in this report are subject to at least five limitations. First, reporting of detailed case data and race and ethnicity to CDC is incomplete. Although this analysis was restricted to 16 jurisdictions with more complete case and race and ethnicity information, 23% of cases from these jurisdictions were missing data on race and ethnicity. Differences in data completeness by race and ethnicity could lead to underestimation of disparities.[10] Restriction to 16 jurisdictions also limits the generalizability of these findings, because they are based on only 23% of the national population of persons aged <25 years; in addition, disparities could vary at geographic subdivisions within states. Second, these data likely underestimate the incidence of COVID-19 among persons aged <25 years because individual-level cases reported to CDC represent a portion of jurisdictional aggregate cases and asymptomatic persons are less likely to be tested. Third, cases among racial and ethnic minority groups might be disproportionately underreported given disparities in access to testing, leading to underestimation of disparities. Fourth, potential differences in testing, reporting, and completeness of data by race and ethnicity over time call for caution in interpretation of the observed changes in racial and ethnic disparities in this report. Finally, racial and ethnic disparities in COVID-19 incidence (and changes over time) might not reflect disparities in severe outcomes††††.[1–3]

During January 1–December 31, 2020, substantial racial and ethnic disparities in COVID-19 incidence, observed early in the pandemic among persons aged <25 years in 16 jurisdictions, decreased over time, driven largely by a greater increase in reporting of cases among White persons. The largest persistent disparities were among NH/PI, AI/AN, and Hispanic persons. Ensuring equitable and timely access to preventive measures, including testing, safe work and education settings and vaccination when eligible is important to address racial/ethnic disparities.§§§§