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Review 1: "The Unequal Burden of the Covid-19 Pandemic: Racial/Ethnic Disparities in US Cause-Specific Mortality"

This preprint contributes new evidence that Black and Hispanic populations share the greatest burden of COVID-19 pandemic. Reviewers found main claims to be strong and potentially informative. There are important implications for policy and practice.

Published onOct 21, 2021
Review 1: "The Unequal Burden of the Covid-19 Pandemic: Racial/Ethnic Disparities in US Cause-Specific Mortality"
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key-enterThis Pub is a Review of
The Unequal Burden of the Covid-19 Pandemic: Racial/Ethnic Disparities in US Cause-Specific Mortality

ABSTRACTObjectivesTo quantify changes in all-cause and cause-specific mortality by race and ethnicity between 2019 and 2020.MethodsUsing 2019 and 2020 provisional death counts from the National Center for Health Statistics and population estimates from the US Census Bureau, we estimate age-standardized death rates by race/ethnicity and attribute changes in mortality to various causes of death. We also examine how patterns of change across racial/ethnic groups vary by age and sex.ResultsCovid-19 death rates in 2020 were highest in the Hispanic community whereas Black individuals had the largest increase in all-cause mortality between 2019 and 2020. Increases in mortality from heart disease, diabetes, and external causes of death accounted for the adverse trend in all-cause mortality within the Black population. Percentage increases in all-cause mortality were similar for men and women and for ages 25-64 and 65+ for Black and White populations, but increases were greatest for working-aged men among the Hispanic population.ConclusionsExamining increases in non-Covid-19 causes of death is essential for fully capturing both the direct and indirect impact of the Covid-19 pandemic on racial/ethnic mortality disparities.

RR:C19 Evidence Scale rating by reviewer:

  • Strong. The main study claims are very well-justified by the data and analytic methods used. There is little room for doubt that the study produced has very similar results and conclusions as compared with the hypothetical ideal study. The study’s main claims should be considered conclusive and actionable without reservation.


Review: This manuscript, by Luck et al., links data from the National Center for Health Statistics to population estimates from the US census bureau to: 1)Measure the increase in all-cause mortality between 2019 and 2020 by age, race/ethnicity (limited to Black, White and Hispanic) and sex; and 2)Measure the attribution to COVID vs non-COVID of any increase in death during this time period (as evidenced by the death certificate attestation). The authors further examine the distribution of increase in cause-specific mortality (the most common of which were diabetes, heart disease and other) stratified by age, race/ethnicity, and sex between the years. The premise of the study is that though mortality with COVID-19 disproportionately affected racial ethnic minorities as described in multiple reports, population level death rates had not been examined to describe the contribution of non-COVID, or misclassified COVID, deaths to these findings. Descriptive statistics are used to report on absolute differences in death events by cause between pre-COVID (2019) and COVID (2020) years, stratified by pre-selected demographic categories, to elucidate above. The authors then used ordinary least squares regression applied to trend in deaths between 2015-2019, to extrapolate expected death by race/ethnicity in 2020 for all cause and non-COVID mortality causes. The analytic methods are sound, and the study claims are justified. The authors successfully show that COVID-infection deaths disproportionately affected Hispanic men between ages 24 and 65, while deaths related to heart disease and diabetes were mostly responsible for the dramatic increase in mortality among Black individuals during the COVID period. They also found that though actual all-cause mortality rates were higher than predicted for 2020, actual and predicated mortality rates for heart disease and diabetes were within 1.6% of each other (2019 and 2020) in all groups. The supported inferences made by this study are very relevant to the current understanding of the effects of COVID among racial/ethnic minorities. The strength of the study comes from its use of national data with full capture of all death events (in hospital and out) with minimal sampling bias which has been unavoidable in other reports of COVID outcomes concentrating on those afflicted by COVID only, or health-system/county or state level databases. The authors are clear in their descriptions of potential misclassification bias. Their explanations for their findings are supported by literature at large and by their data


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