COVID-19 Deaths by Race and Ethnicity in the Ten Across Region

by KATHERINE SYPHER and CRAIG HELMSTETTER | May 3, 2021

Editor’s note: This article is part of a collaboration between APM Research Lab and the Ten Across initiative, housed at Arizona State University.

COVID-19, a disease caused by a coronavirus with no known biological predisposition toward any racial or ethnic group, has nonetheless disproportionately impacted populations of color. Data compiled by the Centers for Disease Control and Prevention confirm that racial and ethnic minority groups are at an increased risk of COVID-19-related infection and hospitalization, and the APM Research Lab’s analyses show that those same groups are dying at higher rates from the virus.

Indigenous Americans are about 1.5 times as likely to become infected, about 3.5 times more likely to be hospitalized, and about 2.5 times more likely to die from COVID-19 than White Americans. Similarly, Black and Hispanic/Latino Americans are about three times more likely to be hospitalized and about twice as likely to die from COVID-19 than White Americans.

Experts warn more world health emergencies are inevitable. As the nation becomes increasingly diverse­, what could these disparate health outcomes bode for future pandemics?

Though there are many ways to answer this question, one is to look at how the pandemic is playing out among states that already look like America’s future. The states tied together by Interstate 10—California, Arizona, New Mexico, Texas, Louisiana, Mississippi, Alabama, and Florida, together forming the “Ten Across” (10X) region—are an example of one such observatory.

The U.S. Census Bureau predicts that the United States will reach so-called “majority minority” status by 2045, when populations of color will outnumber non-Hispanic White Americans for the first time ever. In the southern strip of the country, that is already a reality: 55% of the 10X region’s population is made up of Asian, Black, Indigenous, Latino, and multiracial residents.

What can this region tell us about what will happen during future pandemics, when the entire nation will be more diverse?

At first glance, the 10X region has fared no better or worse than the rest of the nation in terms of COVID-19 impacts. The region is home to 34% of the nation’s population as well as roughly one-third of the nation’s COVID-19 cases and deaths.

Looking at the most extreme form of COVID-19 impact—deaths—in the 10X region, the potential future looks mixed, with some states far surpassing others in death rates among different groups.  

Since the risk of death increases with age, and COVID-19 has had a drastic effect on older Americans, we adjusted our COVID-19 mortality data to account for the varying median ages of different racial and ethnic populations. Doing so allows more apples-to-apples comparison of mortality rates between racial groups by setting aside the age differences between these groups. For more detail on how we age-standardize the rates, see the notes at the bottom of this page.

When adjusted for age, the cumulative COVID-19 death rate increases for all groups in the 10X region except White populations, which decreases. This is because White populations are generally older than populations of color.

From December 2020, to March 2021, Indigenous Americans consistently experienced an age-adjusted death rate far higher than any other racial or ethnic group. Latino and Black populations experienced the second and third highest deaths rates, while White and Asian populations experienced the lowest.

The cumulative mortality rates from the most recent data collection are somewhat lower among populations of color in the 10X states than in the rest of the country. As shown below, the one major exception is among the region’s Indigenous populations, which have experienced far higher death rates from COVID-19 than the Indigenous populations of the nation.

Indigenous Americans suffered an age-adjusted COVID-19 mortality rate of over 580 deaths per 100,000 in the 10X region. This is well above the already alarming national rate of 401 among the Indigenous population nationwide. However, other populations of color in the 10X region—Asian, Black, Latino, Pacific Islander, and White Americans—all recorded lower death rates than the United States as a whole.

When broken down by state, some states stand out as having drastically higher death rates for certain groups.

Indigenous Americans in Mississippi were especially hard hit by the virus, with a death rate over double that of the 10X region as a whole. Arizona and New Mexico, which are home to more than 40 Native American tribal communities—including the Navajo Nation, the largest U.S. Indian reservation—also recorded higher death rates among Indigenous populations than the entire region.

Black Americans living in Louisiana and Mississippi experienced the highest death rates for that population in the 10X states. By the end of March 2020, the Louisiana Department of Health reported that over 70% of residents who died from COVID-19 were Black. In May that same year, the Mississippi Department of Health had a similar finding—Black residents made up 57% of the COVID-19 cases and deaths, but only 38% of the state’s population.

Louisiana also recorded the highest age-adjusted death rate among Asian and White Americans living in the 10X region, while Mississippi had the second highest rates for both groups.

Only three states in the I-10 corridor tracked COVID-19 statistics for Pacific Islanders: California, Louisiana, and Texas. Among two of the states that did report those numbers, the age-adjusted death rates are high, though below the national average of 312 deaths per 100,000. California reported about 307 deaths per 100,000 and Texas reported about 265 deaths per 100,000. Louisiana recorded fewer than 15 total deaths, and so an age-adjusted death rate was not calculated.

Florida consistently recorded the lowest or one of the lowest death rates for each population, well below those of the 10X region and the country. California, Arizona and Texas generally recorded death rates consistent with those in the I-10 corridor and the country, with notable exceptions among Arizona and Texas’ Indigenous and Latino populations.

Apart from Indigenous peoples living in the region, populations of color in the 10X states recorded slightly lower death rates than the entire country. What’s driving these trends is unclear. 

Perhaps people living in parts of the 10X region are more likely to wear masks, or other local government and community public health measures are succeeding. Michigan saw a significant reduction in the racial disparities of their COVID cases and deaths thanks to the efforts of communities of color and state and local officials. Their success is thought to be a result of a combination of factors, including people’s willingness to wear masks and movement of the virus around the state, though the surge in cases and deaths among the state’s White population likely also played a part. It can’t be known for certain, but similar efforts in the 10X region may possibly be having the same effect.

It is also possible that the death data provided by states doesn’t tell the whole story. Nearly every 10X state records a fraction of their deaths as “Unknown” or “Other” rather than in a designated race or ethnicity category. As a result, it is impossible to fully know the distribution of deaths by race and ethnicity in each state.

To view the actual (crude) COVID-19 mortality rates collected for the Ten Across region, as well as every other state, visit APM Research Lab’s Color of Coronavirus. 

Regardless, the pandemic has unquestionably had a disproportionately negative impact on populations of color. According to the World Health Organization, the COVID-19 pandemic has exploited the unfair and preventable inequities that exist in people’s health, wellbeing, and access to healthcare. Experts chalk up these inequities to the social determinants of health, the circumstances in which a person is born, lives, and grows old. They include factors like socioeconomic status, education, neighborhood, and access to quality healthcare, among others.

Historically, social determinants of health have prevented racial and ethnic minority groups from attaining equal emotional and physical health. According to the Kaiser Family Foundation, the COVID-19 pandemic has only exacerbated existing health disparities even further.

Experiencing poverty, working an essential job, living in crowded conditions, and lacking access to reliable transportation may all be linked to poor COVID-19 outcomes—all phenomena that disproportionately affect people of color.

About 27% of households of color in the United States are multigenerational, with a large percentage of those residing in the 10X region, and during the pandemic those close living quarters may contribute to the spread of the virus among family members. And while the population sizes of Black, Latino, and Indigenous Americans are growing in the United States, their collective economic well-being is not rising along with them.

People of color are also less likely to have health insurance. States in the 10X region have some of the highest uninsured rates in the country. Texas has the highest rate—nearly 20% of the population doesn’t have health insurance. And four states—Alabama, Florida, Mississippi, and Texas—are among the 12 that have not expanded access to Medicaid under the Affordable Care Act.

So what can we learn from our COVID-19 mortality data from the 10X region?

While Indigenous peoples living in the region reported a concerning heightened mortality rate, other populations of color recorded marginally lower death rates than the rest of the country. Though we don’t know what’s driving these trends and the improvement is small, every life saved makes a valuable difference and is a step in the right direction. And people across the region are striving to take those steps. Indigenous groups, for instance, have worked incredibly hard to protect and promote the health of their communities.

Still, the greater racial and ethnic diversity within the 10X region does not appear to have led to the improved and equitable health outcomes that we might have hoped for. We would hope that larger populations of color would lead to their increased representation in leadership positions that have the power to influence and improve health equality. For example, Black patients tend to have better health outcomes when treated by Black physicians. But even if greater population diversity doesn’t immediately translate into greater representation in medicine or politics—or at least, it hasn’t yet—it may lead to increased sensitivity to the issues those populations face.

By acting as a window into the country’s future, the 10X region prompts us to deeply question the patterns—the good and the bad—that have unfolded within it during this pandemic and how the nation might better address pandemics yet to come.