Improved measurement of racial/ethnic disparities in COVID-19 mortality in the United States.

Different estimation methods produce diverging accounts of racial/ethnic disparities in COVID-19 mortality in the United States. The CDC's decision to present the racial/ethnic distribution of COVID-19 deaths at the state level alongside re-weighted racial/ethnic population distributions -- in effect, a geographic adjustment -- makes it seem that Whites have the highest death rates. Age adjustment procedures used by others, including the New York City Department of Health and Mental Hygiene, lead to the opposite conclusion that Blacks and Hispanics are dying from COVID-19 at higher rates than Whites. In this paper, we use indirect standardization methods to adjust per-capita death rates for both age and geography simultaneously, avoiding the one-sided adjustment procedures currently in use. Using CDC data, we find age-and-place- adjusted COVID-19 death rates are 80% higher for Blacks and more than 50% higher for Hispanics, relative to Whites, on a national level, while there is almost no disparity for Asians. State-specific estimates show wide variation in mortality disparities. Comparison with non- epidemic mortality reveals potential roles for pre-existing health disparities and differential rates of infection and care.

不同的估算方法对美国新冠疫情死亡率中的种族/族裔差异得出了不同的结论。美国疾控中心决定在州一级呈现新冠死亡的种族/族裔分布以及重新加权的种族/族裔人口分布——实际上是一种地理调整——这使得白人似乎死亡率最高。包括纽约市卫生和心理卫生局在内的其他机构所使用的年龄调整程序则得出相反的结论，即黑人和西班牙裔死于新冠的比率高于白人。在本文中，我们使用间接标准化方法同时针对年龄和地理因素调整人均死亡率，避免了目前使用的片面调整程序。利用美国疾控中心的数据，我们发现在全国范围内，经过年龄和地域调整后，黑人的新冠死亡率比白人高80%，西班牙裔比白人高50%以上，而亚洲人几乎没有差异。各州的具体估算显示死亡率差异存在很大差异。与非疫情死亡率的比较揭示了先前存在的健康差异以及感染率和医疗护理差异可能起到的作用。