A new research letter in JAMA Network Open demonstrates that pre-COVID disparities in all-cause mortality have largely persisted after the acute phase of the pandemic, as patterns have largely returned to baseline.
The study examined annualized age-standardized death rates (ASDRs) among major demographic groups in the United States from March 2018 through May 2023. Sex, race and ethnicity, metropolitan status, and region were all considered.
The authors compared mortality ratios between four periods: One year prior to the pandemic, the first and second years of the pandemic (before and after widespread vaccination), and the post-acute Omicron-dominant phase of the pandemic.
American Indian, Alaskan Native groups hit harder
During the pandemic, mortality rates increased significantly for men, people of color, non-urban residents, and people in the South and West. In almost all groups, levels returned to prepandemic levels by fourth period analyzed. However, the authors said a notable change was that American Indian or Alaska Native ASDRs compared to White mortality was 1.02 (1.01-1.03) to 1.20 (1.18-1.21) or higher in both acute pandemic years.
"Death rate ratios during the postacute period generally returned to prepandemic levels," the authors said. "Although mortality remains somewhat higher than before the pandemic, this additional mortality is largely proportional to 2018-2019 mortality with respect to major demographic comparisons.
This continuity suggests that these disparities are persistent; even a pandemic-level mortality shock does not permanently alter them.
"This continuity suggests that these disparities are persistent; even a pandemic-level mortality shock does not permanently alter them."
