1. Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.
- Author
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Feyman Y, Avila CJ, Auty S, Mulugeta M, Strombotne K, Legler A, and Griffith K
- Subjects
- Humans, Ethnicity statistics & numerical data, Hispanic or Latino statistics & numerical data, Pandemics, United States epidemiology, White statistics & numerical data, Black or African American statistics & numerical data, American Indian or Alaska Native statistics & numerical data, Health Status Disparities, Healthcare Disparities economics, Healthcare Disparities ethnology, Healthcare Disparities statistics & numerical data, Systemic Racism ethnology, Systemic Racism statistics & numerical data, Health Services Accessibility, Employment economics, Employment statistics & numerical data, Occupations economics, Occupations statistics & numerical data, COVID-19 epidemiology, COVID-19 ethnology, Veterans statistics & numerical data
- Abstract
Objective: The COVID-19 pandemic disproportionately affected racial and ethnic minorities among the general population in the United States; however, little is known regarding its impact on U.S. military Veterans. In this study, our objectives were to identify the extent to which Veterans experienced increased all-cause mortality during the COVID-19 pandemic, stratified by race and ethnicity., Data Sources: Administrative data from the Veterans Health Administration's Corporate Data Warehouse., Study Design: We use pre-pandemic data to estimate mortality risk models using five-fold cross-validation and quasi-Poisson regression. Models were stratified by a combined race-ethnicity variable and included controls for major comorbidities, demographic characteristics, and county fixed effects., Data Collection: We queried data for all Veterans residing in the 50 states plus Washington D.C. during 2016-2020. Veterans were excluded from analyses if they were missing county of residence or race-ethnicity data. Data were then aggregated to the county-year level and stratified by race-ethnicity., Principal Findings: Overall, Veterans' mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. However, there was substantial variation by racial and ethnic group. Non-Hispanic White Veterans experienced the smallest relative increase in mortality (17%, 95% CI 11%-24%), while Native American Veterans had the highest increase (40%, 95% CI 17%-73%). Black Veterans (32%, 95% CI 27%-39%) and Hispanic Veterans (26%, 95% CI 17%-36%) had somewhat lower excess mortality, although these changes were significantly higher compared to White Veterans. Disparities were smaller than in the general population., Conclusions: Minoritized Veterans experienced higher rates excess of mortality during the COVID-19 pandemic compared to White Veterans, though with smaller differences than the general population. This is likely due in part to the long-standing history of structural racism in the United States that has negatively affected the health of minoritized communities via several pathways including health care access, economic, and occupational inequities., (© 2022 Health Research and Educational Trust.)
- Published
- 2023
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