Disparities in COVID-19 mortality in the United States, 2020–2023

The COVID-19 pandemic disproportionately affected various demographics and regions in the United States. Understanding disparities in COVID-19 mortality is essential for promoting health equity and guiding future responses. To examine demographic and regional disparities in age-adjusted and proportionate COVID-19 mortality in the US from 2020 to 2023. In this repeated cross-sectional study, data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database were used to analyze death certificates from 2020 to 2023 for COVID-19-related mortality among persons aged ≥ 15 years in the U.S. Age-adjusted mortality rate (AAMR) per 100,000 persons, Rate ratio (with 95% CI), and proportionate mortality of COVID-19, calculated using descriptive statistics. From 2020 to 2023, 1,167,362 (8.91%) of 13,098,787 total deaths in the U.S. were attributed to COVID-19. The AAMR peaked in 2021 at 147.0 (95% CI: 146.6–147.5) per 100,000, with 13.45% of all deaths related to COVID-19, decreasing to 23.1 (2.49%) by 2023. Males exhibited a 1.56-fold higher AAMR than females. Non-Hispanic (NH) American Indian/Alaska Native experienced the highest cumulative AAMR (154), followed by NH Native Hawaiian/Pacific Islander (124.2) and NH African American (123.9) populations. Hispanics had the highest proportionate mortality, with COVID-19 contributing to 23.55% of all deaths in 2021. The oldest age group (≥ 75 years) had the highest cumulative AAMR, 71.6 times higher compared to the youngest group (15–44 years), whereas the highest proportionate mortality was seen in middle-aged adults (45–74 years). Regionally, the Southern U.S. census region recorded the highest cumulative and annual AAMR, except for the Northeast, in 2020. From 2020 to 2023, males, older adults, and racial/ethnic minority groups, notably NH AI/AN, NH NH/PI, NH African American, and Hispanic populations, experienced higher COVID-19 mortality. Regionally, the Southern U.S. Census region had the highest COVID-19 mortality, except for the Northeast, in 2020. These disparities underscore the importance of implementing equitable public health strategies and ensuring preparedness for future health crises. Not applicable