COVID-19 deaths: CDC may underestimate risk for people of color

• The way in which the Centers for Disease Control and Prevention (CDC) report COVID-19 deaths may lead to an underestimation of racial and ethnic disparities, according to a new study.
• The authors say that the CDC use a statistical method called “weighting” that discounts the impact of the uneven geographical distribution of COVID-19 deaths in the United States among various racial and ethnic groups.
• They argue that this approach fails to take into account the range of factors that influence where people live and work.
• This is important because these factors may also influence the risk of COVID-19.

Over the past year, available data have shown that people of different races and ethnicities face different degrees of risk when it comes to having severe COVID-19 or dying of the disease.

Black people in the U.S. reportedly face a 3.5 times higher risk of death from COVID-19, compared with white people in the country.

Another study, analyzing health data from U.S. veterans, found that Hispanic and Black Americans were twice as likely to test positive for COVID-19 than their white peers.

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Yet another study confirmed that “There were excess COVID-19 deaths across all ages” among Black, Hispanic, American Indian, and Alaska Native populations, compared with the deaths among white people in the U.S.

The CDC also report that these same populations have a higher risk of infection, hospitalization, and death related to COVID-19 than the white population.

But just how accurately do authorities report the risk of COVID-19 and related mortality?

The CDC’s current ways of assessing the impact in communities of color are lacking, according to a new study from the University of North Carolina at Chapel Hill and Michigan State University, in East Lansing.

The researchers make their argument in a study paper that appears in the American Journal of Epidemiology.

Why is ‘weighting’ problematic?

“COVID-19 is the latest in a long line of infectious diseases that have disproportionately burdened racialized minority communities in the U.S. The heightened susceptibility of racialized minorities to these diseases is neither biological nor coincidental; rather, it is evidence of structural racism,” the study authors write.

Moreover, they say, U.S. authorities’ current means of assessing COVID-19 death risk may fail to accurately account for the impact of this structural racism.

The National Center for Health Statistics (NCHS) at the CDC have the task of assessing and reporting the percentage of COVID-19 deaths that occur across racial and ethnic groups.

They report both the percentage of COVID-19 deaths that occur in each group and the percentage of the total U.S. population that each major race and ethnicity represents.

However, the NCHS advise against comparing these percentages because, “Such a comparison does not adequately account for the fact that the racial and ethnic distribution of the places hardest hit by COVID-19 is different from that of the entire U.S.,” the study authors explain.

As a result, the CDC use “weighting,” a statistical method meant to improve the accuracy of estimated data.

With this method, “Each individual living in the U.S is multiplied by the COVID-19 deaths that have occurred in his or her county,” leading to a weighted population estimate.

The study authors say that this means that some people will appear in the weighted population estimate thousands of times — and some not at all — depending on the number of COVID-19 deaths in their counties.

And this approach, the authors explain, fails to account for the fact that where individuals live, work, and attend school is driven by systemic inequities.

“This essentially erases the idea that so much of where you live, and where you have access to live, is determined by your race-ethnicity. And they kind of washed that away,” says social epidemiologist Dr. Grace Noppert, the study’s senior author.

“The case we make is that this is a really dangerous way of looking at these disparities.”

‘The risk of reproducing inequalities’

The researchers’ point? “We don’t want to control for geography because it’s such a big part of this story. Rather, we want to explain that geography is intimately tied to structural racism,” Dr. Noppert explains.

With the current weighting approach, percentages of Black and Latinx populations are estimated to be higher than the actual numbers.

Thus, the study authors write, while Black and Latinx people actually make up 31% of the total U.S. population, in the weighted population, these groups combined account for 47.6% of the total.

This means that the burden of COVID-19 deaths among Black and Latinx people is underrepresented in the country’s official estimates.

The researchers argue that “a risk-based approach that directly estimates and compares risks of death across racial and ethnic groups” would be more appropriate.

Such an approach would take into account the real number of COVID-19 deaths per 10,000 people in each racial or ethnic group.

“If we really want our research to be useful and reflect reality, not just our own perspective, we have to think more critically,” says first study author Lauren Zalla, a doctoral candidate at the University of North Carolina’s Odum Institute for Research in Social Science.

“It’s easy to conduct an analysis without thinking too deeply about history and sociology. But I think we run the risk of reproducing the inequalities that we’re trying to reduce when we take an approach that’s not informed by history and the social forces that shape population health.”

– Lauren Zalla

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