The color of coronavirus:
COVID-19 deaths by race and ethnicity in the U.S.

 

by ELISABETH GAWTHROP | October 20, 2022

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Editors note: This is a re-launched version of our original Color of Coronavirus project, which ran from April 2020 through March 2021. That project was based on harvesting data from the COVID-19 statistics reported separately from each state. Since that time the CDC’s National Center for Health Statistics has developed a more robust system of tracking COVID-19 mortality, based on death certificates. While not without some issues (especially a known undercounting of American Indian deaths, which we address below) this data set is even more comprehensive than was the case in our original reporting of these issues. Even as we regret that tracking COVID-19 deaths is still a relevant pursuit, we hope that you will find our work meaningful and helpful in addressing the pandemic and understanding its impacts. As always, we welcome your feedback and insights (info@apmresearchlab.org).

The United States’ official COVID-19 death toll has now surpassed 1,060,000 deaths. Our ongoing Color of Coronavirus project monitors how and where COVID-19 mortality is inequitably impacting certain communities — to guide policy and community responses. Relying on data from the U.S. Centers for Disease Control and Prevention, we have documented the race and ethnicity for 99% of these cumulative deaths in the United States. We highlight national trends in this report, but state-level data is also available in the graphics below and through our GitHub.

Last month, we started including a new section featuring a one-time analysis that highlights a different way of looking at COVID mortality and race data. We are continuing that, this month looking more in depth at state-by-state data. Our usual updates on the pandemic’s cumulative death toll are still included below.

In many states, white Americans now have highest crude COVID-19 death rates

Since last month's Color of Coronavirus, the CDC updated the state-by-state quarterly mortality dataset with data from the second quarter of 2022. While we have cumulative numbers that are more recent at the state level, this quarterly dataset is the one that allows us to look at how mortality patterns shift over time by race and ethnicity at the state level.

The new data reflects trends we've seen at the national level and covered last month – in recent months, white Americans have been the racial or ethnic group with the highest crude mortality rate, closely followed by Indigenous Americans but well ahead of other groups.

 
 

But that is certainly not the whole story. As has been the case with statistics throughout the pandemic, there is no one metric that perfectly summarizes the respective burdens of different groups. So, below are a few different ways of looking at the latest state-by-state numbers.

Looking at the second quarter data for 2022 as reported directly by CDC suggests that white Americans saw the highest crude mortality rates in 46 states. West Virginia and Kentucky had the highest rates, with a crude rate of 15 and 14.9 deaths per 100,000, respectively, for the white residents in those states. That rate of about 15 per 100,000 was also higher than any statewide rate including all race and ethnicity groups for any state during the second quarter. The next highest crude mortality rate for a specific group was 13.9 deaths per 100,000 for Indigenous residents in Alaska.

 
 

But, and it's a significant but, the CDC only reports quarterly numbers for groups for which at least 10 deaths occurred. When between one and nine deaths occur, the data is suppressed. With a bit of data wrangling, though, we can calculate the suppressed numbers too. That's what's shown in the next map.

 
 

Using these numbers, white Americans saw the highest crude mortality rates in 33 states. Indigenous and Pacific Islander Americans went from having the highest rates in two and zero states, respectively, to ten and five states.

A reason for caution, though, when comparing states: some of these high rates are based on a very small number of deaths where the denominator (i.e. a race/ethnicity group's total population in that state) is also relatively small. When the numbers are this small, there’s a higher chance that simple clerical errors or other confounding variables could be playing an outsized role and potentially misrepresent mortality rates.

For example, with this method, Pacific Islanders in Missouri have the highest crude mortality rate in nation for the second quarter, at 23 per 100,000. But that is based on just two deaths and a total population of 8,702 Pacific Islanders. If the racial background of just one of these two individuals were mis-identified, that would result in a dramatically different death rate for that group.

Regardless of whether we use the suppressed or unsuppressed data, the prevalence of states where white Americans have the highest death rates in recent months is a big change from the pattern we see over the entire course of the pandemic.

Higher mortality rates for Indigenous, Pacific Islander and Black Americans from earlier in the pandemic contribute to these groups having the highest cumulative mortality rate in 35 states and Washington, D.C. In the remaining 15 states, white Americans have the highest crude mortality rate.

 
 

Even using the cumulative data for the whole pandemic, this map may overstate the number of states where white Americans have the highest COVID-19 death rate. In some states, smaller populations have not had more than nine deaths, and thus their data remains suppressed. At the most extreme is Vermont, where the only group with ten or more deaths is white Americans. For most other race and ethnicity groups there, we know that between one and nine people have died, but we can't calculate a rate based on that range.

Finally, age-adjustment is a critical step when trying to understand relative risk based on race and ethnicity. This is because age greatly increases someone’s risk of dying of COVID-19, and there are varying distributions of age among different race and ethnicity groups. (Much more on that further down in this report.)

The next map shows the group in each state with the highest mortality rate for the entire pandemic after adjusting for age. In 30 states and Washington, D.C., the group with the highest mortality rate changes after adjusting for age. Using this method, Black Americans have had the highest mortality rate in 24 states, Indigenous Americans in 10, Latino Americans in 10, white Americans in four and Pacific Islander Americans in three.

 
 

While this metric in some ways gets closer to a better estimate of comparing the relative risk of COVID mortality by race, there are again shortcomings. There are some combinations of groups and states that do not have an age-adjusted rate calculated, even when they do have a crude rate calculated. As an example, we only have enough data to calculate age-adjusted rates for Pacific Islanders in three states: Washington, California and Hawaii. In all three of those states, that group has the highest age-adjusted rate. We don’t know if that would be the case in more states if there were sufficient numbers to be able to do the age adjustment. And we definitely can’t calculate an age-adjusted rate where we can’t even calculate a crude mortality rate for a specific group.

Nonetheless, the age-adjusted map illustrates how adjusting for age can change which group has the highest mortality rate in many states. And all of these maps taken together illustrate the complexity of determining the impact of COVID-19 by race and ethnicity.

And now for our usual update.

In August, the most recent month for which mortality data is nearly complete, deaths increased by four percent compared to July for Americans overall. The number of deaths increased for Americans who were Indigenous, white or of more than one race. Black Americans had the same number of deaths in July and August. Deaths decreased for Asian, Latino and Pacific Islander Americans.

As of October 12, the CDC is reporting 13,518 COVID-19 deaths in August. That translates to 436 deaths per day. This marks the fourth month in a row of an increasing number of deaths after a low point in April of 6,207 deaths.

In September, the federal government distributed the highest number of COVID-19 shots, 44.2 million, since January, and last month also saw the highest number of vaccine doses administered, 12.5 million, since April. Most of the doses administered were booster shots. For more on the latest vaccination rates in states across the country, visit our Inoculation Nation page.

When looking at the cumulative mortality burdens of each group as a share of their respective populations, Indigenous Americans continue to suffer the highest rates of loss — a position they have held since early November 2020 — followed by Pacific Islander and Black Americans.

KEY FINDINGS (from data through October 12, 2022):

Note: these numbers are sourced from this CDC dataset, the total count of which sometimes differs slightly from the total count reported on the CDC’s primary mortality landing page. Also, time series data used in this report’s figures lags behind these cumulative numbers due to incompleteness of recent data. 

  • Of the approximately 1,058,186 cumulative official COVID-19 deaths in the U.S., these are the numbers of lives lost by group: Asian (33,086), Black (148,966), Indigenous (11,524), Latino (165,652), Pacific Islander (2,220) and white Americans (689,749). Additionally, 6,989 deaths are recorded as “other” race.

  • These are the documented, nationwide (U.S. states + D.C.) crude mortality impacts from COVID-19 data for all racial and ethnic groups since the start of the pandemic.

    • 1 in 211 Indigenous Americans have died (or 474 deaths per 100,000)

    • 1 in 276 Pacific Islander Americans have died (or 362 deaths per 100,000)

    • 1 in 278 Black Americans have died (or 360 deaths per 100,000)

    • 1 in 285 white Americans have died (or 351 deaths per 100,000)

    • 1 in 370 Latino Americans have died (or 270 deaths per 100,000)

    • 1 in 585 Asian Americans have died (or 171 deaths per 100,000)

  • Indigenous Americans have the highest crude COVID-19 mortality rates nationwide — about 2.8 times as high as the rate for Asian Americans, who have the lowest crude rates. And, the CDC notes that Indigenous American deaths are often undercounted, with the latest research suggesting the true mortality rate for this group could be around 34% higher than official reports.

  • Indigenous, Latino, Pacific Islander and Black Americans all have significantly higher COVID-19 mortality rates than either white or Asian Americans once the data are adjusted to account for age distribution differences among racial and ethnic groups. Nationally, every group except for white Americans has a higher mortality rate after accounting for age, and Latino Americans see the greatest increase between crude and age-adjusted rates. Age adjusting allows for more apples-to-apples comparison among racial and ethnic groups.

Age adjusting is a common and important tool that health researchers use when diseases carry varying levels of risk depending on age. In the case of COVID-19, risks are higher for older populations, and racial and ethnic groups in the U.S. have differing proportions of older populations relative to the rest of their populations. As noted by the CDC, “adjusting by age is important because risk of infection, hospitalization, and death is different by age, and age distribution differs by racial and ethnic group. If the effect of age is not accounted for, racial and ethnic disparities can be underestimated or overestimated.”

We’ve included some key assumptions and caveats, as well as an explanation of age adjusting, at the bottom of the page and we’ve made our full code and methods available on our GitHub repository.

EXAMINE THE DATA:

1. TRENDS: EXPLORE DATA FOR THE U.S. OR A SINGLE STATE OVER TIME

Crude mortality rate or Number of reported deaths

2. TOTALS: EXPLORE DATA FOR THE U.S. OR A SINGLE STATE

Crude mortality rates and age-adjusted mortality rates or Number of reported deaths

3. EXPLORE DATA BY GROUP AND COMPARE AMONG STATES ON A MAP

Asian Americans | Black Americans | Indigenous Americans | Latino Americans |
Native Hawaiian & Other Pacific Islander Americans | White Americans

FOCUS ON ASIAN AMERICANS

Lives lost to date

  • 33,086 Asian Americans are known to have lost their lives to COVID-19 through October 12, 2022. There were 434 new deaths reported among Asian Americans for the last full month of data (August 2022), which is a 10% decrease from the preceding month (481). 

  • Nationwide, Asian Americans have experienced 3.1% of all deaths, while they represent 5.9% of the population.

Crude mortality rate

  • For every 100,000 Asian Americans, about 171 have died from the coronavirus, a mortality rate lower than all other racial or ethnic groups.

  • In eight states, more than 1 in 500 Asian American residents have died from COVID-19 (i.e., more than 200 per 100,000).

Age-adjusted mortality rate

  • Nationwide, Asian Americans have the lowest age-adjusted mortality rate (210 per 100,000), followed by white Americans (286).

  • Once adjusted for age, the highest COVID-19 mortality rates for Asian Americans are in Nevada (378), Minnesota (376), New York (341), Wisconsin (340) and Arizona (259).

Note: Nationwide statistics are derived from CDC reporting at the national level and are not suppressed. State level statistics are suppressed by CDC when the number of deaths is between 1-9.

FOCUS ON BLACK AMERICANS

Lives lost to date

  • 148,966 Black Americans are known to have lost their lives to COVID-19 through October 12, 2022. There were 1,356 new deaths reported among Black Americans for the last full month of data (August 2022), which is the same number of deaths as occurred in the preceding month.

  • Nationwide, Black Americans have experienced 14.1% of all deaths, while they represent 12.6% of the population.

Crude mortality rate

  • For every 100,000 Black Americans, about 360 have died from the coronavirus. This is a little more than double the rate of Asian Americans, who have had the lowest rate, and about 25% less than Indigenous Americans, who have the highest rate.

  • In 37 states and Washington, D.C., more than 1 in 500 Black residents have died (i.e., more than 200 per 100,000).

Age-adjusted mortality rate

  • Nationwide, the age-adjusted mortality rate for Black Americans (466 per 100,000) is about 2.2 times that of the group with the lowest age-adjusted mortality rate, which is Asian Americans (210 per 100,000).

  • Adjusting for age highlights a disparity in deaths between white and Black Americans in particular — the two groups have similar crude mortality rates, but the Black American age-adjusted mortality rate is 68% higher than the same measure for white Americans.

  • Once adjusted for age, the highest COVID-19 mortality rates for Black Americans are in Mississippi (619), Iowa (603), Nevada (578), New Jersey (575) and Michigan (564).

Note: Nationwide statistics are derived from CDC reporting at the national level and are not suppressed. State level statistics are suppressed by CDC when the number of deaths is between 1-9.

FOCUS ON INDIGENOUS AMERICANS

The CDC notes that Indigenous American deaths are often undercounted, with the latest research suggesting the true mortality rate for this group could be around 34% higher than official reports.

Lives lost to date

  • At least 11,524 Indigenous Americans are known to have lost their lives to COVID-19 through October 12, 2022. There were 93 new deaths reported among Indigenous Americans for the last full month of data (August 2022), which is a 9% increase compared to July deaths (85). 

  • Nationwide, Indigenous Americans have experienced 1.1% of all deaths, while they represent 0.7% of the population.

Crude mortality rate

  • For every 100,000 Indigenous Americans, about 474 have died from the coronavirus. This is about 2.8 times the rate of Asian Americans, who have had the lowest rate, and about 30% more than Pacific Islander Americans, who have the next-highest rate after Indigenous Americans.

  • In 31 states, more than 1 in 500 Indigenous American residents have died (i.e., more than 200 per 100,000). Note: there are an additional six states for which it’s possible this threshold has also been crossed but for which we cannot calculate the crude rate due to suppressed values.

Age-adjusted mortality rate

  • Nationwide, Indigenous Americans have the highest age-adjusted mortality rate (582 per 100,000).

  • Once adjusted for age, the highest COVID-19 mortality rates for Indigenous Americans are in North Dakota (1,422), New Mexico (1,257), Montana (1,249), South Dakota (1,146) and Arizona (1,121).

Note: Nationwide statistics are derived from CDC reporting at the national level and are not suppressed. State level statistics are suppressed by CDC when the number of deaths is between 1-9.

FOCUS ON LATINO AMERICANS

Lives lost to date

  • 165,652 Latino Americans are known to have lost their lives to COVID-19 through October 12, 2022. There were 1,102 new deaths reported among Latino Americans for the last full month of data (August 2022), which is down 4% from the number of deaths reported in July (1,149).

  • Nationwide, Latino Americans have experienced 15.7% of all deaths, while they represent 18.6% of the population.

Crude mortality rate

  • For every 100,000 Latino Americans, about 270 have died from the coronavirus. This is about 58% more than the rate of Asian Americans, who have had the lowest rate, and about 23% less than white Americans.

  • In 16 states and Washington D.C., more than 1 in 500 Latino residents have died (i.e., more than 200 per 100,000).

Age-adjusted mortality rate

  • Nationwide, Latino Americans see the biggest increase when adjusting for age — from 270 per 100,000 to 492 per 100,000. This also means that they go from having a crude mortality rate less than that of white Americans, to an age-adjusted mortality rate that is 72% higher than white Americans.

  • Once adjusted for age, the highest COVID-19 mortality rates for Latino Americans are in Arizona (646), District of Columbia (636), Texas (627), Oklahoma (596) and New York (546).

Note: Nationwide statistics are derived from CDC reporting at the national level and are not suppressed. State level statistics are suppressed by CDC when the number of deaths is between 1-9.

FOCUS ON PACIFIC ISLANDER AMERICANS

Lives lost to date

  • 2,220 Pacific Islander Americans are known to have lost their lives to COVID-19 through October 12, 2022. There were 13 new deaths reported among Pacific Islander Americans for the last full month of data (August 2022), which is down 32% from the deaths reported in July (19).

  • Nationwide, Pacific Islander Americans have experienced 0.21% of all deaths, while they represent 0.19% of the population.

Crude mortality rate

  • For every 100,000 Pacific Islander Americans, about 362 have died from the coronavirus. This is similar to Black Americans, more than double that of Asian Americans and about 24% less than Indigenous Americans, who have the highest crude mortality rate.

  • In 25 states, more than 1 in 500 Pacific Islander residents have died (i.e., more than 200 per 100,000). Note: there are an additional 18 states for which it’s possible this threshold has also been crossed but for which we cannot calculate the crude rate due to suppressed values.

Age-adjusted mortality rate

  • Nationwide, Pacific Islander Americans have the third-highest age-adjusted mortality rate (486 per 100,000), just under Latino Americans (492).

  • Washington (892), California (580) and Hawaii (255) are the only states for which age-adjusted rates are calculated, due to statistical requirements.

Note: Nationwide statistics are derived from CDC reporting at the national level and are not suppressed. State level statistics are suppressed by CDC when the number of deaths is between 1-9.

FOCUS ON WHITE AMERICANS

Lives lost to date

  • 689,749 white Americans are known to have lost their lives to COVID-19 through October 12, 2022. There were 10,458 new deaths reported among white Americans for the last full month of data (August 2022), which is a 6% increase from the preceding month (9,898).

  • Nationwide, white Americans have experienced 65.2% of all deaths, while they represent 59.7% of the population.

Crude mortality rate

  • For every 100,000 white Americans, about 351 have died from the coronavirus. This is somewhat less than Black and Pacific Islander Americans, and about double that of Asian Americans, who have the lowest crude mortality rate. Indigenous Americans have the highest rate, about 35% more than white Americans.

  • In 45 states, more than 1 in 500 white residents have died (i.e., more than 200 per 100,000).

Age-adjusted mortality rate

  • Nationwide, white Americans are the only group with an age-adjusted COVID-19 mortality rate (286 per 100,000) that is lower than the crude rate (351).

  • Once adjusted for age, the highest COVID-19 mortality rates for white Americans are in Mississippi (428), Kentucky (415), Oklahoma (414), Tennessee (398) and Alabama (380).

Note: Nationwide statistics are derived from CDC reporting at the national level and are not suppressed. State level statistics are suppressed by CDC when the number of deaths is between 1-9.

SOURCES
Mortality Data
  • For total counts and for calculating cumulative crude rates and age-adjusted rates: CDC/NCHS - Distribution of COVID-19 Deaths and Populations, by Jurisdiction, Age, and Race and Hispanic Origin.
  • For counts over time and for crude rates over time, monthly/national: CDC/NCHS - Provisional COVID-19 Deaths: Distribution of Deaths by Race and Hispanic Origin.
  • For counts over time and for crude rates over time quarterly/states: CDC/NCHS - AH Quarterly Excess Deaths by State, Sex, Age, and Race.
    • According to the CDC, about 91% of these deaths have COVID-19 indicated as the underlying cause of death, while for the other 9% COVID-19 is one of multiple causes of death.

    Population Data
    Mid-Year 2020 U.S. Census Data accessed via CDC-WONDER
  • National populations by race, all ages combined.
  • State-level populations by race, all ages combined.
  • For age adjustment, national population by age groups: Non-Hispanic, Hispanic.
  • For age adjustment, state populations by age groups: Non-Hispanic, Hispanic.

    • All calculations and subsequent analysis are by APM Research Lab and available on our GitHub.
    NOTES
    Race and Ethnicity Groups
    Our labels of each race/ethnicity group correspond as follows:
  • Latino — Hispanic or Latino ethnicity of any race
  • Pacific Islander — Non-Hispanic Native Hawaiian or Other Pacific Islander
  • Indigenous — Non-Hispanic American Indian or Alaska Native
  • White — Non-Hispanic white
  • Black — Non-Hispanic Black or African American
  • Asian — Non-Hispanic Asian
  • More than one race — Non-Hispanic more than one race
    • As noted above, Indigenous American deaths are known to be underreported by 34%. According to the CDC, deaths are also known to be underreported for non-Hispanic API (3%) and for Hispanic decedents (3%).
    Some CDC datasets include a "more than one race" racial category and some include an "other" category. We have included the data that indicates more than one race when available, for which there is also an overall population figure available as a denominator when calculating rates. No such denominator is available for calculating rates for the "other" category. The deaths listed in the "other" category constitute less than 1% of total reported deaths.
    Age-Adjusted Rates
    While there are many features of the novel coronavirus that are still unclear, this we know with certainty: The risk of dying from COVID-19 rises sharply with advanced age. According to the CDC, people 65-74 years old have 65 times the risk of dying from COVID-19 compared to people aged 18-29. That risk increases to 140 times higher for people in the 75-84 age bracket, and 340 times for people age 85 or older.

    Due to this steep age gradient to COVID-19 mortality, it is important to consider the varying age distributions of America's racial and ethnic groups. A higher share of white Americans are in the older age brackets than any other group. And even within the same race groups, the age distribution varies by location—with retirement destination states such as Florida having a much higher share of older adults within their white population, for example.

    To remove the role of these age differences from COVID-19 mortality rates, we have also produced age-adjusted rates. There are two main categories of methods used to produce age-adjusted rates: direct and indirect standardization. The direct method uses the age distribution of COVID-19 deaths within a race/ethnicity group, while the indirect method takes the total number of COVID-19 deaths within a race/ethnicity group and applies mortality rates by age group from the national level (all races) to the age distribution of that race/ethnicity group.

    We have used the direct method where possible, but the direct method requires knowing the numbers of deaths for each age grouping for each race and, when calculating at the state level, for each state. For states with smaller populations, there are instances where not all of the age groupings reach the threshold of at least 10 to be released by CDC. For these suppressed groups/places, we have used the indirect method to calculate an age-adjusted rate.

    To evaluate the accuracy of the indirectly age-adjusted rates, we compared direct and indirect rates where possible. Most indirect rates were within 5% of the direct rates. Some were up to 10% different and two were approaching 15% different. The higher errors tended to be for groups/places with lower numbers of COVID-19 deaths. For this reason, we chose to not calculate indirect rates for groups/places with fewer than 200 COVID-19 deaths. The indirect rates tended to be higher than the direct rates, but not universally.

    All of these numbers are available for download on our GitHub, including an indication of whether the age-adjustment for a particular group/place has been directly or indirectly calculated.

    What do the results of these calculations mean? The age-adjusted rates indicate that many younger Americans who are Black, Latino, Indigenous or Pacific Islanders are dying of COVID-19—driving their mortality rates far above that of white and Asian Americans. Despite their relative youthfulness (a protective factor against COVID), their death rates are elevated.

    It is important to note that, while age-adjusted mortality rates help us remove the influence of age differences in racial groups to examine disparities in outcomes, they are not the actual mortality rates experienced by these groups.

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