Over the course of the COVID-19 pandemic, analyses of federal, state, and local data have shown that people of color have experienced a disproportionate burden of cases and deaths. They have shown particularly large disparities in cases and deaths for Black and American Indian and Alaska Native (AIAN) people and in cases among Hispanic people compared to their White counterparts. Based on weekly data on COVID-19 infections and deaths from CDC, this analysis examines racial disparities in COVID-19 cases and deaths and how they have changed over time. It updates an October 2021 analysis to reflect data through early 2022, amid the recent surge associated with the Omicron variant.
Disparities in Total COVID-19 Cases and Deaths
Cumulative data over time show persisting disparities in cases for Hispanic people and deaths for Black people. As of February 15, 2022, the Centers for Disease Control and Prevention (CDC) reported a total of over 61.4 million cases, for which race/ethnicity was known for 65% or over 40.3 million, and a total of over 780,000 deaths, for which race/ethnicity was known for 85% or over 660,000. These estimates are based on a subset of data for which case-level demographic information has been reported to CDC by state health departments so they differ from those reported elsewhere. For example, CDC reports a total of over 920,000 deaths from COVID as of February 15, 2022. As shown in Figure 1, among cases and deaths with known race/ethnicity:
- Hispanic people represent a larger share of cases relative to their share of the total population (24% vs. 18%), while their share of deaths is more proportionate to their share of the population (17% vs. 18%). The disparity in cases relative to their share of the population has decreased slightly over time. For example, as of early October 2021, they accounted for 27% of cases.
- Black people make up a similar share of cases relative to their share of the population (13%), but account for a slightly higher share of deaths compared to their population share (14% vs. 13%). This pattern has been consistent since October 2021.
- AIAN and Native Hawaiian and Other Pacific Islander (NHOPI) people make up similar shares of cases and deaths relative to their shares of the population, which is consistent with data as of October 2021.
- White people account for a lower share of cases compared to their share of the population (54% vs. 60%) but a larger share of deaths compared to their population share (63% vs. 60%). The higher share of deaths relative to their share of the population reflects a shift from October 2021, when their share of deaths was slightly lower than their share of the population. This shift largely reflects a higher death rate compared to other groups during the fourth quarter of 2022, amid the Omicron surge.
- Consistent with data as of early October 2021, Asian people make up a lower share of cases and deaths compared to their population share (4% and 3%, respectively, vs. 6%).
When data are adjusted to account for differences in age distribution by race/ethnicity (i.e., people of color are generally younger than White people), there are larger disparities for Hispanic, Black, and AIAN people. Figure 2 shows the risk of infection, hospitalization, and death for Black, Hispanic, Asian, and AIAN people compared to White people based on age-adjusted rates across these groups. Adjusting for age is important because risk of infection, hospitalization, and death varies by age, and age distribution differs by racial and ethnic group. If the age is not accounted for, racial and ethnic disparities can be underestimated or overestimated. These age-standardized data show that Hispanic, Black, and AIAN people are about twice as likely to die from COVID-19 as their White counterparts and that Hispanic and AIAN people are at one and a half times greater risk of COVID-19 infection than White people. These data also show large disparities in COVID-19 hospitalizations for AIAN, Black, and Hispanic people. These overall disparities in age-adjusted risk for infection, hospitalization, and death have narrowed over time. For example, as of November 30, 2020, Hispanic, Black, and AIAN people were almost 3 times as likely to die from COVID-19 and about 4 times as likely to be hospitalized as White people. CDC does not report these data for NHOPI people.
Changes in Disparities in Cases and Deaths Over Time
Analysis of weekly data on COVID-19 infections and deaths from CDC shows disparities in infections and deaths have both widened and narrowed over the course of the pandemic (Figure 3). These analyses are based on case and death rates that have not been adjusted for age. These unadjusted rates likely underestimate racial disparities, particularly for COVID-19 deaths, since the White population is older compared to populations of color and COVID-19 death rates have been higher among older individuals. During periods in which the virus has surged, disparities have generally widened, while they have narrowed when overall infection rates fall. However, over the course of the pandemic, specific patterns of disparities have varied by race and ethnicity and between cases and deaths.
Trends in Cases
- Early in the pandemic Hispanic, AIAN, and Black people had higher rates of COVID-19 cases compared to their White counterparts, with a particularly high rate among Hispanic people. Asian people had the lowest weekly infection rate. Case rates increased through Winter 2021, spiking in January 2021, and disparities further widened for Hispanic and AIAN people.
- Following the spike in January 2021, weekly infection rates fell across all groups. By early June 2021, gaps between groups narrowed.
- However, by mid-August 2021, infection rates rose again across groups, reflecting the spread of the Delta variant. Rates were initially higher for Black, Hispanic, and AIAN people compared to White people during this resurgence. By September 2021, infection rates across Black, Hispanic, and White people had mitigated and come closer together. In contrast, the AIAN case rate continued to rise and remained higher compared to other groups, while Asian people maintained the lowest infection rate.
- As of January 2022, infections sharply rose again across all groups amidst the spread of the Omicron variant, resulting in the highest case rates recorded since the start of the pandemic. Rates were higher for all groups of color compared to White people, with Hispanic people having the highest infection rate during this surge. As of January 8, 2022, the infection rate among Hispanic people was more than twice as high as the rate for White people (1,104 vs. 570.5 per 100,000 people). This surge was also the first time since early in the pandemic that the infection rate for Asian and Pacific Islander people was higher compared to other groups.
- As of early February 2022, infection rates had fallen sharply, and disparities once again narrowed. This may reflect an overall decline in cases as well as some lags in the data reporting.
Trends in deaths
- Between Spring 2020 and the early part of Summer 2020, AIAN, Hispanic, and Black people had higher death rates compared to White and Asian people, with a particularly high death rate among AIAN people. Death rates fell over the course of Summer 2020 and disparities narrowed, although death rates for AIAN people remained higher compared to other groups. Deaths peaked in December 2020 across groups, with the highest death rates among AIAN and Hispanic people.
- Following this peak, weekly death rates fell across racial and ethnic groups and differences between groups narrowed by early Summer 2021.
- By mid-August 2021, death rates rose, reflecting the spread of the Delta variant, with a particularly large increase for AIAN people. Death rates were similar for Black and White people, while they remained slightly lower for Hispanic people and lowest for Asian people. Following the Delta surge, weekly death rates decreased across racial and ethnic groups, with a slightly lower rate for Hispanic and Black people compared to White people by late September 2021.
- Death rates remained highest for AIAN people and lowest for Asian people through the arrival of the Omicron variant in early December 2021, at which time death rates for AIAN people decreased compared to White people. While the death rate for Hispanic people remained lower compared to White people, death rates among Black people rose and were similar to the rate for White people and higher compared to other groups by January 1, 2022. Data are not yet available to assess patterns through the remainder of the Omicron surge.
In sum, these data show that, overall, Black, Hispanic, and AIAN people have experienced higher rates of COVID-19 infection and death compared to White people, particularly when accounting for age differences across racial and ethnic groups. The data also suggest that while these disparities have narrowed at times over the course of the pandemic, people of color are disproportionately impacted by surges caused by new variants, with disparities widening during these periods, particularly for infection rates. However, the pattern for death rates amid part of the Omicron surge has varied from earlier surges with White and Black people having the highest rates of death during this period.
Amid the most recent surge associated with the Omicron variant, all groups of color have experienced higher rates of infection compared to White people, with a particularly large spike in cases for Hispanic people. This surge was also the first time since early in the pandemic that the infection rate for Asian and Pacific Islander people was higher compared to other groups. The higher rates of infection among people of color likely reflect increased exposure risk due to working, living, and transportation situations, including being more likely to work in jobs that cannot be done remotely, to live in larger households, and to rely on public transportation. Black and White people have experienced the highest death rates amid the latest surge, although the data for deaths are lagged and do not reflect the full period of the surge. This pattern may reflect higher rates of death among older groups and in nonmetropolitan areas amid the recent surge as well as in the Southern region of the country, which is home to larger shares of the Black population. It may also reflect other factors, including differences in vaccination rates and mitigation measures across groups and different areas of the country. While there have been a significant number of breakthrough cases during the Omicron surge, vaccination – particularly with boosters – continues to be highly effective at reducing the risk of hospitalization and death. Looking ahead, continuing to assess COVID-19 health impacts by race/ethnicity is important for both identifying and addressing disparities and preventing against further widening of disparities in health going forward. While disparities in cases and deaths have narrowed and widened over time for some groups due to a variety of factors, the underlying structural inequities in health and health care and social and economic factors that placed people of color at increased risk at the outset of the pandemic remain. As such, they may remain at increased risk as the pandemic continues to evolve and for future health threats.