Where health inequities have landed in the long tail of the COVID-19 pandemic

Work from this department analyzing California death records has significantly contributed to the current understanding that COVID-19 has hit marginalized racial and ethnic communities unduly hard. Postdoctoral fellow Hélène Aschmann, PhD, recently tackled national mortality data over a longer stretch of the pandemic to paint a more detailed picture of COVID’s effects on longstanding health inequalities in the United States.

In a research note published yesterday in PNAS, Aschmann – with frequent collaborator Matthew Kiang, PhD, of Stanford; and UCSF fellow travelers Ruijia Chen, PhD; Yea-Hung Chen, PhD; Kirsten Bibbins-Domingo, MD, PhD, MAS; Maria Glymour, ScD, MS; and Alicia Riley, PhD (now at UC Santa Cruz) – shows that, for American Indians and Alaska Natives, their risk of dying from any cause when compared to their white counterparts’ became even more elevated in the winter of 2019-2020 and was still, by February 2022, 2.25 times as high of that of white Americans. Because white people’s risk of mortality also rose, these numbers reflect an even larger problem than they seem to at first blush.

The mortality advantage Hispanic and Asian Americans under age 65 had enjoyed over white Americans in the same age group was eroded during the pandemic, with Hispanics facing disproportionately higher risk of death at two points during 2020. Black Americans’ elevated mortality risk was exacerbated during the pandemic but returned by 2022 to its pre-pandemic degree of disparity.

“It’s tragic that these disparities are disappearing because white people are doing worse,” Aschmann said.

There was some good news. Aschmann explained: “The fact that disparities in mortality fluctuate over time actually suggests that you can do something about them.”

By looking at the data month by month using a method for summarizing trends in death rates called joinpoint regression, the researchers identified some surges in COVID deaths that don’t show up in the overall averages. Asians, American Indians and Alaska Natives, and Pacific Islanders saw a two-part surge beginning in the winter of 2019-2020, but Black people saw only one peak, suggesting that targeted efforts to build trust for the vaccine in Black communities likely had a positive impact.

The implications tie into Aschmann’s primary area of research interest: latent tuberculosis, where the public policy rationale for treating everyone who tests positive is strong – it is the only way to eradicate the disease – while the personal choice to undergo a months-long medical regime just to be sure illness doesn’t develop is harder to make.

“One thing I’m interested in is the prevention of disease and whether on an individual and population level there’s the same interest. This was an opportunity to look at the population-level effect of having insufficient public health policies,” Aschmann said.

Research is ongoing into what public policies might shrink the disparate impact of infectious diseases like COVID and non-communicable diseases such as heart disease on non-white groups in the United States.