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When it came to excess U.S. deaths during the COVID pandemic, racial and ethnic disparities hit younger populations particularly hard, a cross-sectional study showed.

People ages 25 to 64 had the greatest increases in observed-to-expected all-cause mortality ratios, and these were highest among American Indian/Alaska Native (1.45), Hispanic (1.40), and Native Hawaiian/Other Pacific Islander (1.39) groups, Jeremy Faust, MD, of Mass General Brigham in Boston, and colleagues . (Faust is 麻豆传媒's editor-in-chief.)

"Those in the working age group were dying at especially disproportionate rates," co-author Utibe Essien, MD, of the David Geffen School of Medicine at the University of California Los Angeles, told 麻豆传媒. "Not only were minoritized groups exposed to higher rates of COVID because they weren't able to work from home, or they had higher rates of comorbidities, or they had less access to healthcare, but these rates of deaths were just so much higher than what we would have seen in non-COVID years."

While excess mortality was still high across all racial and ethnic groups in the 65+ age group, it did not hit the levels seen in the working-age cohort, the researchers said. This is likely due to a "healthy survivor" effect, they said.

For their study, Faust and colleagues analyzed data from CDC's WONDER database, totaling more than 10.6 million deaths during the COVID-19 public health emergency period of March 2020 until May 2023. The mean age of decedents was 72.7, and the majority were white (74.1%).

Overall, there were more than 1.38 million all-cause excess deaths, with an observed-to-expected ratio of 1.15 (95% CI 1.12-1.18), they reported. That corresponded to about 23 million years of potential life lost (YPLL) during the pandemic.

"This is not a small number," Ziyad Al-Aly, MD, of the VA St. Louis Health Care System, who was not involved in the study, told 麻豆传媒. "Even though we're 5 years after the beginning of the pandemic, it's still jarring to see it written like that."

Among all ages, the racial and ethnic groups with highest observed-to-expected mortality ratios were American Indian/Alaska Native (1.34, 95% CI 1.31-1.37) and Hispanic (1.31, 95% CI 1.27-1.34), they found.

But ratios were highest among those ages 25 to 64, and they were greatest among the aforementioned three groups.

Al-Aly was particularly taken aback by the statistics in the youngest age group, those under 25. There was no excess mortality among Asian and white individuals. However, there was substantial excess mortality among Black (observed-to-expected mortality ratio: 1.19), Native Hawaiian/Other Pacific Islander (1.18), American Indian/Alaska Native (1.16), and Hispanic (1.15) groups.

"The group most sensitive to years of life lost is actually the younger people," Al-Aly told 麻豆传媒. "It's a failure of us as a society to protect these individuals."

Faust and colleagues reported that if the rate of excess mortality among whites was applied to the total population, more than 252,000 fewer excess deaths and more than 5.2 million fewer YPLL would have occurred. That includes more than 133,800 fewer excess deaths and more than 2.9 million YPLL in the Hispanic population alone, they noted.

They also found that gaps in disparities widened during the pandemic. Compared with the white population, the prepandemic relative risk of all-cause mortality was 1.07 for American Indian/Alaska Native, rising to 1.22 during the pandemic. Among Black individuals, the prepandemic relative risk of 1.19 rose to 1.26 during the pandemic, they found.

This showed that "existing mortality disparities among certain groups widened during the COVID-19 era, rather than merely having been amplified by universal increases in mortality incident rates, an effect especially pronounced among working-aged adults," the researchers wrote.

They concluded that "while pandemics are inevitable, disparities are not. The need to address the conditions that create health disparities -- before the next public health crisis -- is evident."

"Four years later we're seeing a much clearer picture of how dire the disparities during COVID were," Essien told 麻豆传媒. "We have a moment now to think more broadly as a country about how we improve access to care so we don't have to wait until the next pandemic to think about those disparities. We can eliminate some of the barriers to healthy lives today for all people in our country."

Al-Aly agreed that the data should be used to address healthcare disparities in the U.S.: "Now we're able to see with greater clarity these very big differences in mortality," he said. "This is not a trivial outcome. This is death."

"Hopefully this will stimulate more discussion as to why this is happening," he continued, "and how we can put measures in place to fix those inequities."

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