Even beyond hospital walls, COVID-19 hit marginalized communities hardest

The emergence of COVID-19 in the United States in March 2020 affected mortality patterns well beyond the walls of busy intensive care units. Data from the U.S. Department of Transportation showed, for instance, that, although Americans drove less, there were more traffic deaths. A report published in JAMA last year posited that murders rose in the first few months of the pandemic and suicides, paradoxically, fell.

A study published May 9 in JAMA Internal Medicine reveals that deaths from March through the end of 2020 from all external causes – including traffic deaths, homicide, suicide and drug overdose – hit some racial and ethnic groups disproportionately hard. The new study, led by Ruijia Chen, ScD, a postdoctoral fellow in the Department of Epidemiology and Biostatistics, found that suicides fell only among white people, nudging down the average even though other racial and ethnic groups saw no decline. Traffic deaths, meanwhile, rose much more among Black and Hispanic Americans than among other groups.

“These excess deaths come in addition to the disproportionate number of Black and Hispanic lives lost from the virus itself,” Chen said. “Our work only describes the disparities, not the causes, but we think an important next step is to understand what drives them, including possibly neighborhood segregation.”

Drug overdoses are another area where the racial and ethnic breakdown casts a spotlight on a particular affected community. The jump in overdose deaths disproportionately affected American Indian and Alaska Natives (12% over what would be expected according to pre-pandemic trends) and Black people (6% above expectations) much harder than White Americans, Hispanic Americans, Asians and Pacific Islanders, the study shows. 

“The true toll of the pandemic on health in the United States can only be understood by examining impact across different communities and including non-COVID causes of death,” said Kirsten Bibbins-Domingo, MD, PhD, another author of the paper and the chair of the department of epidemiology and biostatistics at UCSF. “An equitable public health response must include a focus on other non-COVID deaths, which are also on the rise.”

The research used death data that is publicly available from the Centers for Disease Control and Prevention, sorting by cause of death and race and ethnicity. It compared those numbers to trend lines established by death records from 2015 through the first two months of 2020.

The work developed from a research project led by Bibbins-Domingo, using California death certificates to show that COVID-19 disproportionately took the lives of Black and Hispanic people in the state. That work showed that those working essential jobs were experienced far more deaths per capita than others. The need to drive to work is one possible explanation for the greater increase in traffic deaths among Blacks and Hispanics nationally, Chen said.

The group is now pivoting to look at national trends, starting with deaths that were clearly not caused directly by COVID-19 to give a fuller picture of the pandemic’s impact.