American Indian/Alaska Native and Black Americans died of murder, suicide, vehicle crashes, and drug overdoses at higher rates than their White and Asian/Pacific Islander peers amid the twin threats of the opioid epidemic and the COVID-19 pandemic, finds a US modeling study published yesterday in JAMA Internal Medicine.
A team led by University of California researchers used monthly death data from the Centers for Disease Control and Prevention’s (CDC’s) Wide-ranging Online Data for Epidemiologic Research (WONDER) database from January 2015 to February 2020 to predict excess deaths occurring from March to December 2020.
High murder rate among Black Americans
In the first 10 months of the pandemic, an estimated 17,251 (95% prediction interval [PI], 8,114 to 26,245) Americans died of murder, suicide, vehicle crashes, and drug overdoses, corresponding to 5.24 excess deaths per 100,000 people. Most fatalities were attributed to murder, drug overdoses, and vehicle accidents.
Estimated excess death rates from all external causes were highest among American Indian/Alaska Native people (17.66 per 100,000; 95% PI, 11.21 to 23.98) and Black individuals (15.41; 95% PI, 11.29 to 19.46) and lowest among Asian/Pacific Islanders (0.27; 95% PI, –0.47 to 1.00).
The highest estimated excess murder rate was among Black Americans (6.7 per 100,000 people; 95% PI, 5.04 to 8.33)—more than twice the rate of the next-highest group (American Indian/Alaska Natives (3.02; 95% PI, 1.68 to 4.32). Black Americans also had the highest estimated per-capita murder rate.
Estimated suicide rates were lower than expected among White Americans (−2,643 excess deaths; 95% PI, –4,517 to –796). While all racial groups had excess deaths from drug overdoses, American Indian/Alaska Natives had the highest per capita rate (11.21 per 100,000 people; 95% PI, 7.67 to 14.69). Excess deaths attributed to vehicle accidents were seen in only Black (1,274 deaths; 95% PI, 948 to 1,594) and Hispanic Americans (468; 95% PI, 154 to 774).
Roles of structural racism, opioids
The study authors said the findings suggest that COVID-19 directly and indirectly contributed to these disparities, but the fundamental cause is structural racism.
“Discrimination against Black and American Indian or Alaska Native populations has left these communities especially vulnerable to the consequences of the pandemic, including worsening poverty, unemployment, housing instability, food insecurity, and decreased access to health care,” they wrote.
For example, they said, barriers to accessing treatment services and obtaining medications such as buprenorphine to treat pain and narcotic addiction may have contributed to drug overdoses in racial and ethnic minorities.
“During the COVID-19 pandemic, riskier driving increased; which, combined with differences in occupations and the ability to work from home, may be associated with higher rates of transportation fatalities in the Black population,” the researchers wrote.
“These results underscore the urgency of addressing the structural determinants of violence, substance use, and transportation deaths among racial and ethnic minority groups, especially among Black and American Indian or Alaska Native communities,” they concluded.
In a related editor’s note, Irving Ling, MD, of the University of California at San Francisco, and Mithi Del Rosario, MD, and Cary Gross, MD, both of the Yale School of Medicine, said the findings must be viewed against a history of racism in communities, institutions, and policies.
“For instance, redlining practices of the 1930s that excluded Black individuals from obtaining government-backed home loans have led to the concentration of poverty in Black communities,” they wrote. “Black families were then further destabilized by the war on drugs, which dates to 1971 in the US, and have experienced high rates of firearm violence even after controlling for socioeconomic status.”
Ling and colleagues said that future research should disaggregate race and ethnicity data across diverse communities. “The findings of Chen et al suggest that previously described racial and ethnic disparities in COVID-19 mortality may be underestimates, as external contributors to mortality were often not incorporated,” they wrote.
“There is an urgent need to actively address structural factors associated with disparities in health outcomes and mortality rates in already marginalized communities.”