Increased COVID-19 mortality among immigrants compared with US-born individuals: a cross-sectional analysis of 2020 mortality data

A M Bacong; R Chu; A Le; V Bui; N E Wang; L P Palaniappan

doi:10.1016/j.puhe.2024.03.016

Increased COVID-19 mortality among immigrants compared with US-born individuals: a cross-sectional analysis of 2020 mortality data

Public Health. 2024 Jun:231:173-178. doi: 10.1016/j.puhe.2024.03.016. Epub 2024 May 3.

Authors

A M Bacong¹, R Chu², A Le³, V Bui⁴, N E Wang⁵, L P Palaniappan⁶

Affiliations

¹ Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, CA, USA; Stanford University Center for Asian Health Research and Education, Stanford, CA, USA. Electronic address: abacong@stanford.edu.
² Stanford University Center for Asian Health Research and Education, Stanford, CA, USA; University of California, Los Angeles Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA, USA; Asian American Studies Department, University of California, Los Angeles, Los Angeles, CA, USA.
³ University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
⁴ University of California, Berkeley School of Public Health, Berkeley, CA, USA.
⁵ Stanford University Center for Asian Health Research and Education, Stanford, CA, USA; Stanford University School of Medicine, Department of Medicine, Division of Emergency Medicine, Stanford, CA, USA.
⁶ Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, CA, USA; Stanford University Center for Asian Health Research and Education, Stanford, CA, USA.

PMID: 38703491
DOI: 10.1016/j.puhe.2024.03.016

Abstract

Objective: Multiple studies have shown that racially minoritized groups had disproportionate COVID-19 mortality relative to non-Hispanic White individuals. However, there is little known regarding mortality by immigrant status nationally in the United States, despite being another vulnerable population.

Study design: This was an observational cross-sectional study using mortality vital statistics system data to calculate proportionate mortality ratios (PMRs) and mortality rates due to COVID-19 as the underlying cause.

Methods: Rates were compared by decedents' identified race, ethnicity (Hispanic vs non-Hispanic), and immigrant (immigrants vs US born) status. Asian race was further disaggregated into "Asian Indian," "Chinese," "Filipino," "Japanese," "Korean," and "Vietnamese."

Results: Of the over 3.4 million people who died in 2020, 10.4% of all deaths were attributed to COVID-19 as the underlying cause (n = 351,530). More than double (18.9%, n = 81,815) the percentage of immigrants who died of COVID-19 compared with US-born decedents (9.1%, n = 269,715). PMRs due to COVID-19 were higher among immigrants compared with US-born individuals for non-Hispanic White, non-Hispanic Black, Hispanic, and most disaggregated Asian groups. Among disaggregated Asian immigrants, age- and sex-adjusted PMR due to COVID-19 ranged from 1.58 times greater mortality among Filipino immigrants (95% confidence interval [CI]: 1.53, 1.64) to 0.77 times greater mortality among Japanese immigrants (95% CI: 0.68, 0.86). Age-adjusted mortality rates were also higher among immigrant individuals compared with US-born people.

Conclusions: Immigrant individuals experienced greater mortality due to COVID-19 compared with their US-born counterparts. As COVID-19 becomes more endemic, greater clinical and public health efforts are needed to reduce disparities in mortality among immigrants compared with their US-born counterparts.

Keywords: Asian American; COVID-19; Health disparities; Hispanic; Mortality.

Publication types

Observational Study
Comparative Study

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
COVID-19* / ethnology
COVID-19* / mortality
Cross-Sectional Studies
Emigrants and Immigrants* / statistics & numerical data
Ethnicity / statistics & numerical data
Female
Humans
Male
Middle Aged
Mortality / ethnology
Mortality / trends
SARS-CoV-2
United States / epidemiology
Young Adult