Although older Americans had the highest number of deaths in the Covid-19 pandemic, younger Americans had the highest rates compared with the overall population – especially among people of color, according to a new study.
And in two groups – Native Hawaiian or other Pacific Islander and Native American or Alaska Native – working-age people (ages 25 to 64) had the greatest increase in mortality of any age group.
It’s “really devastating, because these are individuals who could be contributing to our society and, more importantly, contributing to their families”, said Utibe Essien, an assistant professor of medicine at the David Geffen School of Medicine at UCLA, a primary care physician and one of the co-authors of the study.
“The disparities happen in this working-age population where the implications are so much longer-lasting – that, to me, was the shocking thing,” said Jeremy Faust, an emergency physician at Brigham and Women’s Hospital, assistant professor at Harvard Medical School and lead author of the study.
The researchers calculated excess deaths – the number of people who died compared with the normal rate – finding almost 1.4 million more people died than expected between March 2020 and May 2023.
Working-age Americans saw a 20% increase in mortality rates during the pandemic, while older Americans’ mortality rate increased by 13%.
But among younger populations, the effects were starkly unequal.
Black children and young people under the age of 25 accounted for more than half of the deaths (51%) in that age group, despite only representing 13.8% of the population.
“That’s a staggering fact,” said Elizabeth Wrigley-Field, associate professor of sociology at the University of Minnesota, who was not involved with this study.
“The US has been an exceptionally unequal place for a long time,” she said, and the pandemic “was experienced in profoundly unequal ways”.
Indigenous populations, including Native Americans, Alaska Natives, and Native Hawaiians or Pacific Islanders, also had more under-25 deaths than before the pandemic – but there were no excess deaths among Asian and white populations in the same age group.
Compared with the average working-age American before the pandemic, Native American or Alaska Native people of the same age were 45% more likely to die in the pandemic, while that rate was 40% for Hispanic people and 39% for Native Hawaiians or other Pacific Islanders.
The relative increase in mortality among working-age people is highest because younger people usually don’t die, Wrigley-Field pointed out. “It’s often the case that you see the biggest proportionate changes in younger age groups, just because that’s where mortality is smaller.”
At the same time, she said, the idea that “pandemic mortality is only a story about older people – that stereotype was really incorrect and has misled us about the extent to which this was a disaster that led to deaths very broadly across the population”.
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The US was deeply unequal before the pandemic, but the inequities were magnified even more, experts said.
“There are really wide differences in who has access to treatment – who has access to a primary care doc, who has access to insurance,” Essien said.
Then, in the pandemic, there were inequities among frontline workers who were required to work in person, often without protection; who needed to take public transportation; and who had intergenerational households. There were also disparities in access to lifesaving vaccines once they arrived.
“This pandemic shone a light on the inequities that are structural and are not due to genetics or poor behaviors or poor decisions,” Essien said.
The disparities magnified by the pandemic must be addressed now – not during the next crisis, Essien said.
“How do we take care of our communities and societies today so that the folks who are still alive can continue to be healthy, especially those from underrepresented and minoritized groups?” Essien said.
“What can we be doing today – in our health systems, public health departments, federal government, state governments – to really make sure that people are leading the healthiest lives they can, so that they’re not exposed at such a high risk when a new pandemic happens?”