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      Excess Deaths Associated with COVID-19, by Age and Race and Ethnicity — United States, January 26–October 3, 2020

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          Abstract

          As of October 15, 216,025 deaths from coronavirus disease 2019 (COVID-19) have been reported in the United States*; however, this number might underestimate the total impact of the pandemic on mortality. Measures of excess deaths have been used to estimate the impact of public health pandemics or disasters, particularly when there are questions about underascertainment of deaths directly attributable to a given event or cause ( 1 – 6 ). † Excess deaths are defined as the number of persons who have died from all causes, in excess of the expected number of deaths for a given place and time. This report describes trends and demographic patterns in excess deaths during January 26–October 3, 2020. Expected numbers of deaths were estimated using overdispersed Poisson regression models with spline terms to account for seasonal patterns, using provisional mortality data from CDC’s National Vital Statistics System (NVSS) ( 7 ). Weekly numbers of deaths by age group and race/ethnicity were assessed to examine the difference between the weekly number of deaths occurring in 2020 and the average number occurring in the same week during 2015–2019 and the percentage change in 2020. Overall, an estimated 299,028 excess deaths have occurred in the United States from late January through October 3, 2020, with two thirds of these attributed to COVID-19. The largest percentage increases were seen among adults aged 25–44 years and among Hispanic or Latino (Hispanic) persons. These results provide information about the degree to which COVID-19 deaths might be underascertained and inform efforts to prevent mortality directly or indirectly associated with the COVID-19 pandemic, such as efforts to minimize disruptions to health care. Estimates of excess deaths can provide a comprehensive account of mortality related to the COVID-19 pandemic, including deaths that are directly or indirectly attributable to COVID-19. Estimates of the numbers of deaths directly attributable to COVID-19 might be limited by factors such as the availability and use of diagnostic testing (including postmortem testing) and the accurate and complete reporting of cause of death information on the death certificate. Excess death analyses are not subject to these limitations because they examine historical trends in all-cause mortality to determine the degree to which observed numbers of deaths differ from historical norms. In April 2020, CDC’s National Center for Health Statistics (NCHS) began publishing data on excess deaths associated with the COVID-19 pandemic ( 7 , 8 ). This report describes trends and demographic patterns in the number of excess deaths occurring in the United States from January 26, 2020, through October 3, 2020, and differences by age and race/ethnicity using provisional mortality data from the NVSS. § Excess deaths are typically defined as the number of persons who have died from all causes, in excess of the expected number of deaths for a given place and time. A detailed description of the methodology for estimating excess deaths has been described previously ( 7 ). Briefly, expected numbers of deaths are estimated using overdispersed Poisson regression models with spline terms to account for seasonal patterns. The average expected number, as well as the upper bound of the 95% prediction interval (the range of values likely to contain the value of a single new observation), are used as thresholds to determine the number of excess deaths (i.e., observed numbers above each threshold) and percentage excess (excess deaths divided by average expected number of deaths). Estimates described here refer to the number or percentage above the average; estimates above the upper bound threshold have been published elsewhere ( 7 ). Observed numbers of deaths are weighted to account for incomplete reporting by jurisdictions (50 states and the District of Columbia [DC]) in the most recent weeks, where the weights were estimated based on completeness of provisional data in the past year ( 7 ). Weekly NVSS data on excess deaths occurring from January 26 (the week ending February 1), 2020, through October 3, 2020, were used to quantify the number of excess deaths and the percentage excess for deaths from all causes and deaths from all causes excluding COVID-19. ¶ Deaths attributed to COVID-19 have the International Classification of Diseases, Tenth Revision code U07.1 as an underlying or contributing cause of death. Weekly numbers of deaths by age group (0–24, 25–44, 45–64, 65–74, 75–84, and ≥85 years) and race/ethnicity (Hispanic or Latino [Hispanic], non-Hispanic White [White], non-Hispanic Black or African American [Black], non-Hispanic Asian [Asian], non-Hispanic American Indian or Alaska Native [AI/AN], and other/unknown race/ethnicity, which included non-Hispanic Native Hawaiian or other Pacific Islander, non-Hispanic multiracial, and unknown) were used to examine the difference between the weekly number of deaths occurring in 2020 and the average number occurring in the same week during 2015–2019. These values were used to calculate an average percentage change in 2020 (i.e., above or below average compared with past years), over the period of analysis, by age group and race and Hispanic ethnicity. NVSS data in this report include all deaths occurring in the 50 states and DC and are not limited to U.S. residents. Approximately 0.2% of decedents overall are foreign residents. R statistical software (version 3.5.0; The R Foundation) was used to conduct all analyses. From January 26, 2020, through October 3, 2020, an estimated 299,028 more persons than expected have died in the United States.** Excess deaths reached their highest points to date during the weeks ending April 11 (40.4% excess) and August 8, 2020 (23.5% excess) (Figure 1). Two thirds of excess deaths during the analysis period (66.2%; 198,081) were attributed to COVID-19 and the remaining third to other causes †† (Figure 1). FIGURE 1 Weekly numbers of deaths from all causes and from all causes excluding COVID-19 relative to the average expected number and the upper bound of the 95% prediction interval (A), and the weekly and total numbers of deaths from all causes and from all causes excluding COVID-19 above the average expected number and the upper bound of the 95% prediction interval (B) — National Vital Statistics System, United States, January–September 2020 Abbreviation: COVID-19 = coronavirus disease 2019. The figure is a histogram, an epidemiologic curve showing the weekly numbers of deaths from all causes and from all causes excluding COVID-19 relative to the average expected number and the upper bound of the 95% prediction interval (A), and the weekly and total numbers of deaths from all causes and from all causes excluding COVID-19 above the average expected number and the upper bound of the 95% prediction interval (B), using data from the National Vital Statistics System, in United States, during January–September 2020. The total number of excess deaths (deaths above average levels) from January 26 through October 3 ranged from a low of approximately 841 in the youngest age group (<25 years) to a high of 94,646 among adults aged 75–84 years. §§ However, the average percentage change in deaths over this period compared with previous years was largest for adults aged 25–44 years (26.5%) (Figure 2). Overall, numbers of deaths among persons aged <25 years were 2.0% below average, ¶¶ and among adults aged 45–64, 65–74 years, 75–84, and ≥85 years were 14.4%, 24.1%, 21.5%, and 14.7% above average, respectively. FIGURE 2 Percentage change in the weekly number of deaths in 2020 relative to average numbers in the same weeks during 2015–2019, by age group — United States, 2015–2019 and 2020 The figure is a histogram, an epidemiologic curve showing the percentage change in the weekly number of deaths in 2020 relative to average numbers during the same weeks in 2015–2019, by age group, in the United States, during 2015–2019 and 2020. When examined by race and ethnicity, the total numbers of excess deaths during the analysis period ranged from a low of approximately 3,412 among AI/AN persons to a high of 171,491 among White persons. For White persons, deaths were 11.9% higher when compared to average numbers during 2015–2019. However, some racial and ethnic subgroups experienced disproportionately higher percentage increases in deaths (Figure 3). Specifically, the average percentage increase over this period was largest for Hispanic persons (53.6%). Deaths were 28.9% above average for AI/AN persons, 32.9% above average for Black persons, 34.6% above average for those of other or unknown race or ethnicity, and 36.6% above average for Asian persons. FIGURE 3 Percentage change in the weekly number of deaths in 2020 relative to average numbers in the same weeks during 2015–2019, by race and Hispanic ethnicity — United States, 2015–2019 and 2020 The figure is a histogram, an epidemiologic curve showing the percentage change in the weekly number of deaths in 2020 relative to average numbers in the same weeks during 2015–2019, by race and Hispanic ethnicity, in the United States, during 2015–2019 and 2020. Discussion Based on NVSS data, excess deaths have occurred every week in the United States since March 2020. An estimated 299,028 more persons than expected have died since January 26, 2020; approximately two thirds of these deaths were attributed to COVID-19. A recent analysis of excess deaths from March through July reported very similar findings, but that study did not include more recent data through September ( 5 ). Although more excess deaths have occurred among older age groups, relative to past years, adults aged 25–44 years have experienced the largest average percentage increase in the number of deaths from all causes from late January through October 3, 2020. The age distribution of COVID-19 deaths shifted toward younger age groups from May through August ( 9 ); however, these disproportionate increases might also be related to underlying trends in other causes of death. Future analyses might shed light on the extent to which increases among younger age groups are driven by COVID-19 or by other causes of death. Among racial and ethnic groups, the smallest average percentage increase in numbers of deaths compared with previous years occurred among White persons (11.9%) and the largest for Hispanic persons (53.6%), with intermediate increases (28.9%–36.6%) among AI/AN, Black, and Asian persons. These disproportionate increases among certain racial and ethnic groups are consistent with noted disparities in COVID-19 mortality.*** The findings in this report are subject to at least five limitations. First, the weighting of provisional NVSS mortality data might not fully account for reporting lags, particularly in recent weeks. Estimated numbers of deaths in the most recent weeks are likely underestimated and will increase as more data become available. Second, there is uncertainty associated with the models used to generate the expected numbers of deaths in a given week. A range of values for excess death estimates is provided elsewhere ( 7 ), but these ranges might not reflect all of the sources of uncertainty, such as the completeness of provisional data. Third, different methods or models for estimating the expected numbers of deaths might lead to different results. Estimates of the number or percentage of deaths above average levels by race/ethnicity and age reported here might not sum to the total numbers of excess deaths reported elsewhere, which might have been estimated using different methodologies. Fourth, using the average numbers of deaths from past years might underestimate the total expected numbers because of population growth or aging, or because of increasing trends in certain causes such as drug overdose mortality. Finally, estimates of excess deaths attributed to COVID-19 might underestimate the actual number directly attributable to COVID-19, because deaths from other causes might represent misclassified COVID-19–related deaths or deaths indirectly caused by the pandemic. Specifically, deaths from circulatory diseases, Alzheimer disease and dementia, and respiratory diseases have increased in 2020 relative to past years ( 7 ), and it is unclear to what extent these represent misclassified COVID-19 deaths or deaths indirectly related to the pandemic (e.g., because of disruptions in health care access or utilization). Despite these limitations, however, this report demonstrates important trends and demographic patterns in excess deaths that occurred during the COVID-19 pandemic. These results provide more information about deaths during the COVID-19 pandemic and inform public health messaging and mitigation efforts focused on the prevention of infection and mortality directly or indirectly associated with the COVID-19 pandemic and the elimination of health inequities. CDC continues to recommend the use of masks, frequent handwashing, and maintenance of social distancing to prevent COVID-19. ††† Summary What is already known about this topic? As of October 15, 216,025 deaths from COVID-19 have been reported in the United States; however, this might underestimate the total impact of the pandemic on mortality. What is added by this report? Overall, an estimated 299,028 excess deaths occurred from late January through October 3, 2020, with 198,081 (66%) excess deaths attributed to COVID-19. The largest percentage increases were seen among adults aged 25–44 years and among Hispanic or Latino persons. What are the implications for public health practice? These results inform efforts to prevent mortality directly or indirectly associated with the COVID-19 pandemic, such as efforts to minimize disruptions to health care.

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          Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020

          Efforts to track the severity and public health impact of coronavirus disease 2019 (COVID-19) in the United States have been hampered by state-level differences in diagnostic test availability, differing strategies for prioritization of individuals for testing, and delays between testing and reporting. Evaluating unexplained increases in deaths due to all causes or attributed to nonspecific outcomes, such as pneumonia and influenza, can provide a more complete picture of the burden of COVID-19.
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            Excess Deaths From COVID-19 and Other Causes, March-July 2020

            This study updates a previous report of the estimated number of excess deaths in the US during the coronavirus disease 2019 (COVID-19) pandemic through August 1, 2020, and describes causes of those deaths and temporal relationships with state lifting of coronavirus restrictions.
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              Race, Ethnicity, and Age Trends in Persons Who Died from COVID-19 — United States, May–August 2020

              During February 12–October 15, 2020, the coronavirus disease 2019 (COVID-19) pandemic resulted in approximately 7,900,000 aggregated reported cases and approximately 216,000 deaths in the United States.* Among COVID-19–associated deaths reported to national case surveillance during February 12–May 18, persons aged ≥65 years and members of racial and ethnic minority groups were disproportionately represented ( 1 ). This report describes demographic and geographic trends in COVID-19–associated deaths reported to the National Vital Statistics System † (NVSS) during May 1–August 31, 2020, by 50 states and the District of Columbia. During this period, 114,411 COVID-19–associated deaths were reported. Overall, 78.2% of decedents were aged ≥65 years, and 53.3% were male; 51.3% were non-Hispanic White (White), 24.2% were Hispanic or Latino (Hispanic), and 18.7% were non-Hispanic Black (Black). The number of COVID-19–associated deaths decreased from 37,940 in May to 17,718 in June; subsequently, counts increased to 30,401 in July and declined to 28,352 in August. From May to August, the percentage distribution of COVID-19–associated deaths by U.S. Census region increased from 23.4% to 62.7% in the South and from 10.6% to 21.4% in the West. Over the same period, the percentage distribution of decedents who were Hispanic increased from 16.3% to 26.4%. COVID-19 remains a major public health threat regardless of age or race and ethnicity. Deaths continued to occur disproportionately among older persons and certain racial and ethnic minorities, particularly among Hispanic persons. These results can inform public health messaging and mitigation efforts focused on prevention and early detection of infection among disproportionately affected groups. In NVSS data, confirmed or presumed COVID-19–associated deaths are assigned the International Classification of Diseases, Tenth Revision code U07.1 as a contributing or underlying cause of death on the death certificate. The underlying cause of death is the condition that began the chain of events ultimately leading to the person’s death. COVID-19 was the underlying cause for approximately 92% of COVID-19–associated deaths and was a contributing cause for approximately 8% during the investigation period ( 2 ). NVSS data in this report exclude deaths among residents of territories and foreign countries. Using NVSS data from May 1 through August 31, 2020, CDC tabulated the numbers and percentages of COVID-19–associated deaths by age, sex, race and ethnicity (categorized as Hispanic, White, Black, non-Hispanic Asian [Asian], non-Hispanic American Indian or Alaska Native [AI/AN], non-Hispanic Native Hawaiian or other Pacific Islander [NHPI], non-Hispanic multiracial [multiracial], and unknown), U.S. Census region, § and location of death (e.g., hospital, nursing home or long-term care facility, or residence). Because only 0.5% of COVID-19 decedents were either NHPI or multiracial, and counts <10 are suppressed in NVSS to maintain confidentiality, these groups were combined into one group for analyses. Age, race and ethnicity, and place of death were unknown for two (<0.01%), 465 (0.4%), and 46 (0.04%) deaths, respectively. To describe changes in demographic features over time, percentages of deaths among two age groups (≥65 years and <65 years), racial and ethnic groups, and U.S. Census region were calculated for each month. R statistical software (version 3.6.3; The R Foundation) was used to tabulate death counts and generate histograms. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy. ¶ During May 1–August 31, 2020, a total of 114,411 COVID-19–associated deaths were reported to NVSS (Table). The number of COVID-19–associated deaths decreased from 37,940 in May to 17,718 in June; subsequently, counts increased to 30,401 in July and declined to 28,352 in August. Among decedents, the majority were male (53.3%), White (51.3%), aged ≥65 years (78.2%), and died in an inpatient health care setting (64.3%). Overall, 24.2% of decedents were Hispanic, 18.7% were Black, 3.5% were Asian, 1.3% were AI/AN, and 0.5% were either NHPI or multiracial. During the period studied, the largest percentage of COVID-19–associated deaths occurred in the South Census region (45.7%), followed by the Northeast (20.5%), the West (18.3%), and the Midwest (15.5%). Twenty-two percent of decedents died in a nursing home or long-term care facility. TABLE Demographic characteristics of persons who died because of COVID-19* (N = 114,411) — National Vital Statistics System (NVSS), United States, May 1–August 31, 2020 † Characteristic Deaths,§ % Age group, yrs <1 <0.1 1–4 <0.1 5–17 <0.1 18–29 0.5 30–39 1.4 40–49 3.5 50–64 16.4 65–74 21.7 75–84 26.0 ≥85 30.4 Unknown <0.1 Sex Male 53.3 Female 46.7 Other 0.0 Race/Ethnicity White, non-Hispanic 51.3 Hispanic or Latino 24.2 Black, non-Hispanic 18.7 Asian, non-Hispanic 3.5 American Indian or Alaska Native, non-Hispanic 1.3 Other, non-Hispanic¶ 0.5 Unknown race/ethnicity 0.4 U.S. Census region of residence South 45.7 Northeast 20.5 West 18.3 Midwest 15.5 Place of death Health care setting, inpatient 64.3 Nursing home or long-term care facility 21.5 Decedent's home 5.2 Hospice facility 3.7 Health care setting, outpatient or emergency department 3.1 Other 2.0 Health care setting, dead on arrival 0.1 Unknown <0.1 Abbreviation: COVID-19 = coronavirus disease 2019. * Deaths with confirmed or presumed COVID-19, coded to International Classification of Diseases, Tenth Revision code U07.1. These data exclude deaths among foreign residents and territories. † NVSS data from August are incomplete given reporting lags. § Percentages may not sum to 100 because of rounding. For two (<0.01%) COVID-19 deaths, age was unknown. Sex and region were known for all decedents. For 465 (0.4%) deaths, race or ethnicity were unknown. For 46 (0.04%) deaths, place of death was unknown. ¶ Other race/ethnicity includes persons who were non-Hispanic Native Hawaiian or other Pacific Islander or were non-Hispanic multiracial. During May–August 2020, the percentage of COVID-19–associated deaths occurring in the South increased from 23.4% in May to 62.7% in August, and in the West from 10.6% to 21.4%; the percentages occurring in the Northeast decreased from 44.2% in May to 4.0% in August, and in the Midwest declined from 21.8% to 11.8% (Figure 1). The percentage of decedents aged ≥65 years decreased from 81.8% to 77.6%, and the percentage of deaths occurring in nursing homes or long-term care facilities decreased from 29.8% to 16.6% (Figure 1). FIGURE 1 Monthly COVID-19–associated deaths* as a percentage of all deaths, by U.S. Census region, all ages (A), and for persons aged ≥65 years or persons of any age who died in a nursing home or long-term care facility (B) (N = 114,411) — National Vital Statistics System, United States, May 1–August 31, 2020 Abbreviation: COVID-19 = coronavirus disease 2019. * Age data were missing for two (<0.01%) COVID-19 deaths, and place of death data were missing for 46 (0.04%) deaths. Total numbers of deaths might vary because of suppression of counts with <10 deaths. The figure is a line chart showing monthly COVID-19–associated deaths as a percentage of all deaths, by U.S. Census region, all ages, and for persons aged ≥65 years or persons of any age who died in a nursing home or long-term care facility (N = 114,411), using data from the National Vital Statistics System, in the United States, during May 1–August 31, 2020. From May to August, the percentage of decedents who were White decreased from 56.9% to 51.5%, and the percentage who were Black decreased from 20.3% to 17.4%, whereas the percentage who were Hispanic increased from 16.3% to 26.4% (Figure 2). Hispanics were the only racial and ethnic group among whom the overall percentage of deaths increased. Among persons aged ≥65 years, the monthly percentage of Hispanic decedents increased in the South (from 10.3% to 21.7%) and West (from 29.6% to 35.4%) and decreased in the Northeast (from 11.3% to 9.3%) and Midwest (from 7.8% to 4.2%). The monthly percentage of Hispanic decedents aged <65 years increased in the South (from 29.2% to 38.1%) and West (from 51.8% to 62.3%) and decreased in the Northeast (from 34.9% to 30.7%) and Midwest (31.1% to 20.4%) (Supplementary Figure, https://stacks.cdc.gov/view/cdc/95229). FIGURE 2 Monthly deaths, by race/ethnicity* as a percentage of all COVID-19–associated deaths (N = 114,411) — National Vital Statistics System, United States, May 1–August 31, 2020 Abbreviations: AI/AN = American Indian or Alaska Native; COVID-19 = coronavirus disease 2019; NH = non-Hispanic; NHPI = Native Hawaiian or other Pacific Islander. * Race or ethnicity data were unknown for 465 (0.4%) deaths. Total numbers of deaths might vary because of suppression of counts with <10 deaths. The figure is a bar chart showing monthly deaths, by race/ethnicity as a percentage of all COVID-19–associated deaths (N = 114,411), using data from the National Vital Statistics System, in the United States, during May 1–August 31, 2020. Discussion Based on NVSS data on 114,411 persons who died from COVID-19 in the United States during May–August 2020, the predominant U.S. Census regions shifted from the Northeast to the South and West. The majority of COVID-19–associated deaths occurred among White persons (51.3%), but Black and Hispanic persons were disproportionately represented. Although a small decrease (2.9 percentage points between May and August) in decedents who were Black was observed, Black persons still accounted for 18.7% of overall deaths despite representing just 12.5% of the U.S. population ( 3 ). Similarly, Hispanic persons were disproportionately represented among decedents: 24.2% of decedents were Hispanic compared with 18.5% of the U.S. population. In addition, the percentage of decedents who were Hispanic increased 10.1 percentage points from May through August. Whereas Hispanic persons accounted for 14% of COVID-19–associated deaths in the United States during February 12–May 18, 2020 ( 1 ), that percentage increased to approximately 25% in August. Although there has been a geographic shift in COVID-19–associated deaths from the Northeast to the West and South, where Hispanic persons account for a higher percentage of the population, this analysis found that ethnic disparities among decedents in the West and South increased during May–August, 2020, suggesting that the geographic shift alone does not entirely account for the increase in percentage of Hispanic decedents nationwide. Disparities in COVID-19 incidence and deaths among Hispanic persons and other underrepresented racial and ethnic groups are well documented ( 4 – 6 ) and might be related to increased risk for exposure to SARS-CoV-2, the virus that causes COVID-19. Inequities in the social determinants of health can lead to increased risk for SARS-CoV-2 exposure among some racial and ethnic groups. For example, persons from underrepresented racial and ethnic groups might be more likely to live in multigenerational and multifamily households, reside in congregate living environments, hold jobs requiring in-person work (e.g., meatpacking, agriculture, service, and health care), have limited access to health care, or experience discrimination ( 5 , 6 ). Differences in the prevalence of underlying conditions (e.g., diabetes and obesity) among racial and ethnic groups might also be associated with increased susceptibility to COVID-19–associated complications and death ( 4 ). The shift in COVID-19–associated deaths during May–August 2020 from the Northeast (where 17.1% of the U.S. population resides) into the South and West (where 38.3% and 23.9% of the U.S. population resides, respectively)** is consistent with recent findings documenting the emergence of COVID-19 hotspots †† in these regions during June–July 2020 ( 7 ). The decreasing percentage of deaths occurring among persons aged ≥65 years and persons in nursing homes, which were important sites of COVID-19–associated deaths early in the pandemic, suggests a continued shift toward noninstitutionalized and younger populations. The observed geographic shifts in COVID-19–associated deaths might be related to differential implementation of community mitigation efforts throughout the nation, including earlier reopening efforts in selected jurisdictions. To prevent the spread of COVID-19, CDC continues to recommend the use of masks, frequent handwashing, and maintenance of social distancing, including avoidance of large gatherings ( 8 ). The findings in this report are subject to at least two limitations. First, NVSS provisional death data are continually updated and subject to delays. Therefore, this report likely underestimates the number of deaths that occurred, particularly during August 2020, for which data are less complete than previous months. Furthermore, in focusing only on COVID-19–associated deaths captured by NVSS, this report did not address long-term morbidity faced by some persons who survive COVID-19 infections, nor does it account for deaths and morbidity related to the indirect effects of interrupted health care and socioeconomic disruption caused by the pandemic ( 9 ). For example, one report indicated that by June 30, 2020, an estimated 41% of U.S. adults had delayed or avoided medical care because of concerns about the pandemic, including 12% who reported having avoided urgent or emergency care ( 10 ). Despite these limitations, this report provides information on how demographic and geographic factors have changed among COVID-19–associated deaths during May–August 2020. Racial and ethnic disparities among COVID-19 decedents have persisted over the course of the pandemic and continue to increase among Hispanic persons. These results can inform public health messaging and mitigation efforts focused on prevention and early detection of infection among disproportionately affected groups so as to minimize subsequent mortality. Summary What is already known about this topic? Persons aged ≥65 years and members of minority racial and ethnic groups are disproportionately represented among COVID-19–associated deaths. What is added by this report? Analysis of 114,411 COVID-19–associated deaths reported to National Vital Statistics System during May–August 2020, found that 51.3% of decedents were non-Hispanic White, 24.2% were Hispanic or Latino (Hispanic), and 18.7% were non-Hispanic Black. The percentage of Hispanic decedents increased from 16.3% in May to 26.4% in August. What are the implications for public health practice? These results can inform public health messaging and mitigation efforts focused on prevention and early detection of infection among disproportionately affected groups so as to minimize subsequent mortality.
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                Author and article information

                Journal
                MMWR Morb Mortal Wkly Rep
                MMWR Morb Mortal Wkly Rep
                WR
                Morbidity and Mortality Weekly Report
                Centers for Disease Control and Prevention
                0149-2195
                1545-861X
                23 October 2020
                23 October 2020
                : 69
                : 42
                : 1522-1527
                Affiliations
                [1 ]National Center for Health Statistics, CDC.
                Author notes
                Corresponding author: Lauren M. Rossen, lrossen@ 123456cdc.gov .
                Article
                mm6942e2
                10.15585/mmwr.mm6942e2
                7583499
                33090978
                c83c552e-c9ec-418e-a46e-88371634352e

                All material in the MMWR Series is in the public domain and may be used and reprinted without permission; citation as to source, however, is appreciated.

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