COVID-19 Deaths by Race and Ethnicity

10 Min Read

Dec 21, 2022

By

Hina B. Shah, M.P.H., Phillip Steiner, M.A.
A Kansas Twist Logo

In 2020, COVID-19 quickly became one of the leading causes of death in the United States.  After another peak in early 2022, deaths from COVID-19 have dropped.

Why this matters: Throughout the COVID-19 pandemic, people living in rural areas, immigrants and people who identify as American Indian/Alaska Native, Black or African American, and Hispanic or Latino experienced a disproportionate burden of cases and deaths. In this blog update, KHI takes a closer look at COVID-19 deaths by race and ethnicity.

Sign up here to receive these summaries and more, and also follow KHI on FacebookTwitter and LinkedIn. Previous editions of A Kansas Twist can be found on our ARCHIVE PAGE.

The Kansas Story

What we did: KHI used two approaches to better understand age-adjusted COVID-19 deaths by race and ethnicity in Kansas over the course of the pandemic (2020-2022).

  • In the first approach, KHI reviewed data published by the American Public Media’s Research Lab, which included a side-by-side comparison of the crude and age-adjusted  COVID-19 death rates by race and ethnicity (see Mortality Rates, Crude & Age-Adjusted; Select Kansas; Figure 1a below).
  • In the second approach, KHI compared the age-adjusted COVID-19 deaths to each group’s share of the state’s population (Figure 1b).

Both approaches analyzed data from the U.S. Centers for Disease Control and Prevention (CDC).

Age adjustment is a statistical process applied to death rates that allow comparisons across communities or groups with different age distributions. Because the risk of dying from COVID-19 increases with advanced age (e.g., 60 times higher for those age 65-74 than those age 18-29), it is important to consider the role of varying age distributions among racial and ethnic groups. Hence, age adjustment provides a more accurate comparison.

Approach 1

APM Research Lab Analysis (Figure 1a)

Figure 1A Mortality Rates Crude and Age-Adjusted

How to interpret the data: Crude death rates are the actual number of deaths per 100,000 people in each racial and ethnic group (left side of chart). In comparison, the age-adjusted deaths per 100,000 are calculated for each racial and ethnic group (right bar chart). Missing bars indicate groups with insufficient data for the analysis.

What we found: The APM Research Lab data show that crude COVID-19 mortality rates are similar for Black Kansans and lower for Latino Kansans compared to White Kansans. The age-adjusted COVID-19 mortality rate for Latino and Black Kansans was 1.7 times higher than the age-adjusted COVID-19 mortality rate for White Kansans (527 and 518 compared to 303, respectively).

While not shown due to the smaller sample sizes in Kansas, the U.S. data also showed higher age-adjusted COVID-19 mortality rates among Pacific Islander and Indigenous population groups than White individuals. The results are consistent with the risk for COVID-19 death by race and ethnicity published by the CDC.

Approach 2

KHI Analysis (Figure 1b)

Figure 1b Comparing the Distribution of Age-Adjusted COVID-19 Deaths and the Population in Kansas by Race and Etnicity as of November 2022

How to interpret the data: The left column shows the share of age-adjusted COVID-19 deaths for each racial and ethnic group. In comparison, the right column shows the distribution of the Kansas population by racial and ethnic group. When a population’s share of deaths from COVID-19 is higher than its share of the state’s population (positive percentage point difference), it indicates an unequal share or disparity.

What we found: The data illustrate a higher share of age-adjusted COVID-19 deaths in comparison to their share of the population among all racial and ethnic groups other than White and Other, which includes missing data and those who identify with two or more races.

  • Non-Hispanic White Kansans were 74.1 percent of the state population but were 65.0 percent of age-adjusted COVID-19 deaths in the state (a lower share of deaths; -9.1 percentage point difference). In contrast,
  • Hispanic, Any Race, Kansans were 13.1 percent of the Kansas population but 17.7 percent of the age-adjusted COVID-19 deaths in the state (a higher share of deaths; +4.6 percentage point difference).
  • Non-Hispanic Black Kansans were 5.8 percent of the Kansas population but 9.6 percent of the age-adjusted COVID-19 deaths in the state (a higher share of deaths; +3.8 percentage point difference).

In Summary: Both approaches spotlight the higher burden of age-adjusted COVID-19 deaths among Black and Latino Kansans and potentially for Pacific Islanders, American Indians and Alaska Natives.

What’s behind it: The racial and ethnic disparities in the data could be attributed to differences in risk factors between groups. Nationally, 4 in 10 (41.2 percent) frontline workers are Black, Hispanic, or some category other than White. Frontline workers include those in healthcare, food production, building cleaning services, childcare, and social services, who may have had an increased risk of exposure to COVID-19 and a disproportionately higher infection rate. Another reason could be higher rates of chronic health conditions, such as diabetes or heart disease,  among members of racial and ethnic minority groups, who could have had more severe illness as a result of infection. Finally, there are known differences in access to healthcare between racial and ethnic groups that may have contributed to differences in COVID-19 mortality. For example, in Kansas before the pandemic, Hispanic, Any Race, Kansans were 3.6 times more likely to be uninsured than non-Hispanic White Kansans (22.5 percent compared to 6.3 percent) according to the 2019 American Community Survey.

Regional Trends

Next, KHI explored the changes in racial and ethnic disparity throughout the pandemic by comparing age-adjusted COVID-19 deaths by year for each group. In the absence of Kansas-level data from the U.S. Centers for Disease Control and Prevention (CDC), KHI used regional data.

 What we did: KHI compared the share of age-adjusted COVID-19 deaths by race and ethnicity annually from January 2020 to November 2022 among those who reside in U.S. Department of Health and Human Services (HHS) Region 7, which includes Kansas, Nebraska, Missouri and Iowa (Figure 2).

Figure 2 Share of Age-Adjusted COVID-19 Deaths by Race and Ethnicity for HHS Region 7 January 2020-November 2022

What we found: The number of COVID-19 deaths in HHS Region 7 fell 45.2 percent from 2020 to 2022 (as of November 30), and there was a change in the proportion of age-adjusted COVID-19 deaths among Hispanic, non-Hispanic Black and non-Hispanic White population groups.

  • The proportion of age-adjusted COVID-19 deaths among Hispanic, Any Race, individuals decreased from 7.7 percent to 3.2 percent.
  • The proportion of age-adjusted COVID-19 deaths among non-Hispanic Black individuals decreased from 10.7 percent to 9.2 percent.
  • The proportion of age-adjusted COVID-19 deaths among non-Hispanic White individuals increased from 79.1 percent to 85.6 percent.

What’s behind it: While the COVID-19 variants have become less lethal over time, another reason for the decline in total deaths could be the availability and accessibility of the COVID-19 vaccine. The change in the age-adjusted COVID-19 deaths among Hispanic and non-Hispanic Black Kansans could result from public health efforts targeted around the vaccine rollout, vaccine equity and vaccine hesitancy to increase vaccination rates in communities of color.

Vaccine equity is when everyone has fair and just access to COVID-19 vaccination.

Vaccine hesitancy refers to delay in acceptance or refusal to have a vaccine even when one is available.

In Kansas, in the past two and a half years of the pandemic, several efforts have been made across the state to fund and better understand how to address vaccine equity and vaccine hesitancy. Below are only a few examples of those efforts.

  • In November 2020, the Kansas Leadership Center (KLC) launched “Kansas Beats the Virus” in partnership with the State of Kansas, which was an effort to mobilize Kansas to generate local solutions that can lead to behavior-changing action. In 2020, the effort led to 851 meetings and the development of 827 action plans. In 2021, KLC partnered in a second phase with the Kansas Department of Health and Environment (KDHE) to provide tools and facilitators for communities to create local strategies to increase testing and vaccination rates resulting in 1,010 unique action projects that reached an estimated 1.35 million Kansans across the state. One of the outcomes was “most of the action projects were created by and directed toward racial and ethnic minority populations in Kansas.”
  • In January 2021, two medical professionals, with community partners, in Garden City, created videos in several languages – English, Arabic, Tigrinya, Karen, Vietnamese, Rohingya, Quiche, Pleutdeutsch, Burmese, Spanish, and Somali – to address common concerns and questions around the COVID-19 vaccines.
  • On March 10, 2021, Governor Kelly announced Dr. Ximena Garcia as her special advisor on COVID-19 vaccination equity. Dr. Garcia led the COVID-19 Vaccine Equity Taskforce.
  • In May 2021, several counties – including Wyandotte and Shawnee – began going door-to-door in neighborhoods with high concentrations of Hispanic, Any Race, and Black populations to sign residents up for vaccines.
  • In June 2021, the CDC awarded $31.9 million, including $11.6 million dedicated to rural efforts, to KDHE to address health and COVID-19 vaccine equity among populations at high-risk and underserved, including racial and ethnic minority populations and rural communities.
  • In September 2021, KDHE commissioned NORC at the University of Chicago and the JUNTOS Center for Advancing Latino Health at the University of Kansas Medical Center Research Institute to conduct public opinion research on the sentiments of unvaccinated Kansans related to COVID-19 vaccines and testing. The findings were published in November 2021.
  • On September 27, 2021, Governor Kelly announced a new grant program to “Increase the Reach,” which aimed to reach socially vulnerable populations and those experiencing low vaccination rates, including both racial and ethnic minority populations as well as rural communities.

A few factors may contribute to the increase in the proportion of age-adjusted COVID-19 deaths among the non-Hispanic White population group. For instance, vaccination rates among non-Hispanic White individuals may have stagnated in the third year of the pandemic. In Kansas, KDHE data on COVID-19 vaccination demographics also show the gap has narrowed when compared to Black Kansans or eliminated when compared to Hispanic Kansans. There also are lower vaccination rates in some parts of the state. Another factor could be political ideology and its impact on vaccine uptake.

The bottom line: Data from the CDC show a higher burden of age-adjusted COVID-19 deaths among minority racial and ethnic groups in Kansas. Regionally – in Kansas, Missouri, Nebraska and Iowa – the trend is changing and overall deaths from COVID-19 have dropped in 2022. The share of age-adjusted deaths also has decreased for Hispanic, Any Race, individuals during the three-year period from 2020 to 2022. With a focus on health equity, understanding such trends and evidence-based efforts to identify successes, challenges and lessons learned could shape future actions.

Check back for more information as we continue to monitor the ongoing impact of COVID-19.

About Kansas Health Institute

The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.

Learn More About KHI