• Meredith S Shiels, Anika T Haque, Emily A Haozous, Paul S Albert, Jonas S Almeida, Montserrat García-Closas, Anna M Nápoles, Eliseo J Pérez-Stable, Neal D Freedman, and Amy Berrington de González.
• National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.).
• Ann. Intern. Med. 2021 Dec 1; 174 (12): 1693-1699.

BackgroundAlthough racial/ethnic disparities in U.S. COVID-19 death rates are striking, focusing on COVID-19 deaths alone may underestimate the true effect of the pandemic on disparities. Excess death estimates capture deaths both directly and indirectly caused by COVID-19.ObjectiveTo estimate U.S. excess deaths by racial/ethnic group.DesignSurveillance study.SettingUnited States.ParticipantsAll decedents.MeasurementsExcess deaths and excess deaths per 100 000 persons from March to December 2020 were estimated by race/ethnicity, sex, age group, and cause of death, using provisional death certificate data from the Centers for Disease Control and Prevention (CDC) and U.S. Census Bureau population estimates.ResultsAn estimated 2.88 million deaths occurred between March and December 2020. Compared with the number of expected deaths based on 2019 data, 477 200 excess deaths occurred during this period, with 74% attributed to COVID-19. Age-standardized excess deaths per 100 000 persons among Black, American Indian/Alaska Native (AI/AN), and Latino males and females were more than double those in White and Asian males and females. Non-COVID-19 excess deaths also disproportionately affected Black, AI/AN, and Latino persons. Compared with White males and females, non-COVID-19 excess deaths per 100 000 persons were 2 to 4 times higher in Black, AI/AN, and Latino males and females, including deaths due to diabetes, heart disease, cerebrovascular disease, and Alzheimer disease. Excess deaths in 2020 resulted in substantial widening of racial/ethnic disparities in all-cause mortality from 2019 to 2020.LimitationsCompleteness and availability of provisional CDC data; no estimates of precision around results.ConclusionThere were profound racial/ethnic disparities in excess deaths in the United States in 2020 during the COVID-19 pandemic, resulting in rapid increases in racial/ethnic disparities in all-cause mortality between 2019 and 2020.Primary Funding SourceNational Institutes of Health Intramural Research Program.

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