Racial and Ethnic Disparities in Estimated Excess Mortality From External Causes in the US, March to December 2020

COVID-19 has disproportionately affected racial and ethnic minority groups in the US. 1 However, estimating the full effects of the pandemic on health disparities should account for other causes of death, including external causes. 2 We estimated racial and ethnic disparities in excess deaths from external causes (homicide, suicide, transportation, and drug overdoses) from March through December 2020.Methods | We obtained monthly death data from the Wide-ranging Online Data for Epidemiologic Research (WONDER) database of the Centers for Disease Control and Prevention.After identifying external causes of death with the International Classification of Diseases, Tenth Revision codes, we fitted dynamic harmonic regression models to monthly death count data from January 2015 to February 2020 to forecast deaths from March to December 2020 (eTable in the Supplement).3 We estimated excess deaths and the 95% prediction intervals (PIs) by subtracting the number of forecasted deaths from the number of observed deaths.Race and ethnicity data obtained from death certificates included American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, Hispanic or Latino, and White.Because the study used publicly available, deidentified data on deceased individuals, it was not submitted for human participants review, consistent with guidance from the Stanford University institutional review board.This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.Results | Between March and December 2020, we estimated 17 251 (95% PI, 8114-26 245), excess deaths from all external causes occurred in the US, corresponding to 5.24 (95% PI, 2.46-7.97)estimated excess deaths per 100 000 individuals.Estimated excess deaths were primarily attributable to homicides, drug overdoses, and transportation fatalities (Figure ).Estimated excess death rates from all external causes were highest among American Indian or Alaska Native individuals (17.66 per 100 000 population; 95% PI, 11.21-23.98)and Black individuals (15.41 per 100 000 population; 95% PI, 11.29-19.46),and lowest among Asian or Pacific Islander individuals (0.27 per 100 000 population; 95% PI, -0.47 to 1.00) (Table ).Black individuals had the highest estimated excess homicide deaths per capita (6.7 per 100 000 population; 95% PI, 5.04-8.33)-morethan twice the next highest group (American Indian or Alaska Native individuals (3.02; 95% PI, 1.68-4.32).Lower than expected suicide deaths primarily reflected patterns among White individuals (-2643 estimated excess deaths; 95% PI, -4517 to -796).Although all groups had estimated excess deaths from drug overdose, American Indian or Alaska Native individuals had the highest per capita estimated excess deaths (11.21 per 100 000 population; 95% PI, 7.67-14.69).Excess transportation fatalities were only evident among Black individuals (1274 estimated excess deaths; 95% PI, 948-1594) and Hispanic individuals (468 excess deaths; 95% PI, 154-774).