California's Excess Mortalities During Pandemic Disproportionately Hit Minorities, Old, Poor

Per capita excess mortality was highest among people aged 65 years and older, men, Blacks and Latinos, and those without a college degree.

California saw nearly 20,000 more deaths from March 1 through August 22 than what would be predicted by historical trends, new research shows.

The Golden State recorded 146,557 deaths over the seven-month span between March and August, which is 19,806 more deaths than historical models suggest, according to a research letter in JAMA Internal Medicine.

Per capita excess mortality was highest among people aged 65 years and older, men, Blacks and Latinos, and those without a college degree.

"Following the statewide shelter-in-place, Latino residents and those without a high school degree/GED had the greatest increase in excess per capita mortality, with rates more than tripling after reopening," the UC San Francisco-led researchers wrote.

"We hypothesize that this pattern reflects the risk of COVID-19 death faced by low-wage, essential workers and their social networks owing to occupational exposure, crowded housing, and inadequate access to testing or treatments," they said.

The projections in the research letter are consistent with state and national tracking of COVID-19 deaths. As of December 21, the pandemic had claimed 22,820 lives in California with about 1.9 million cases reported. Nationally, the virus has claimed more than 311,000 lives, with more than 18 million cases reported, according to data compiled by The New York Times.

The research also compared deaths in March through April against deaths in May through August and found that Latinos and those without a high school degree or the equivalent had the greatest increase in excess deaths.

Latino deaths tripled from 16 to 51 excess deaths per 1 million, and deaths in those without a high school degree grew by a factor of 3.4, from 21 to 72 excess deaths per 1 million.

Younger adults had the biggest increases in excess deaths, more than doubling the rate between shutdown and reopening. Ages 25-54 increased from 4 to 11 excess deaths per million, and ages 55-64 grew from 12 to 30 excess deaths per million.

Black people had higher per capita excess mortality than other racial/ethnic group throughout most of the pandemic. However, later in the shelter-in-place period, White, Asian, and Black residents had a decline in excess per capita deaths.

Latinos and those without a high school diploma saw a large and sustained increase in per capita deaths.  

While noting that the research is not designed to determine the effect of policies undertaken during the pandemic, the researchers said their findings "suggest that the policies adopted to date have had disparate outcomes across population subgroups.":

"Our findings underscore the importance of examining the inequitable effects of policies during the pandemic, reexamining the effects over time, and investing in strategies to mitigate the excess mortality in affected communities," the said.

Methodology

Using California Department of Public Health, the researchers evaluated deaths for the entire state and for specific groups by age, sex, race/ethnicity, and educational level, ages 25 or older.

The researchers estimated excess deaths for each week by subtracting the number of forecast deaths from the number of observed deaths.

"For each time period, we obtained 95% prediction intervals by simulating the forecast 10,000 times, selecting the 97.5% and 2.5% quantiles and subtracting the total number of observed deaths," the research letter said.

"We obtained per capita estimates by dividing the excess deaths and corresponding 95% prediction intervals by population size, using estimates from the U.S. Census Bureau."