County-Level Determinants of the Loss of the Hispanic Mortality Advantage in the United States.

Abstract

Background: The COVID-19 pandemic disproportionately impacted the Hispanic population in the United States, leading to an unprecedented decline in the longstanding Hispanic mortality advantage (HMA) and highlighting the need to better understand the sociodemographic and structural factors driving these trends.

Objective: To evaluate the association between county-level determinants (including demographic, socioeconomic, behavioral, healthcare, and structural factors) and declines in the HMA during COVID-19 pandemic.

Participants: Data on non-Hispanic White (NHW) and Hispanic individuals were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research and the Robert Wood Johnson Foundation County Health Rankings databases.

Exposures: County-level sociodemographic and structural factors.

Main measures: In this cross-sectional analysis of national county-level mortality data from 2019 to 2020, the primary outcome was the change in the HMA between 2019 and 2020. All-cause age-adjusted mortality rates (AAMRs) at the county level were used to calculate the HMA (NHW AAMR - Hispanic AAMR). Coronavirus disease 2019 (COVID-19)-specific AAMRs and county-level factors were identified.

Key results: We analyzed 619 US counties with complete and reliable mortality and sociodemographic data from a total of 3193 counties. From 2019 to 2020, the mean AAMR per 100,000 persons increased by 12.5% for NHW, from 765.4 to 861.0, and by 30.3% for Hispanic populations, from 554.5 to 722.3. On average, the HMA per 100,000 persons decreased by 34.2%, from 210.9 to 138.7, with 71.5% counties experiencing a decline in the HMA. County-level factors that were associated with a decline in the HMA included the percentage of Hispanic individuals aged > 65 years, segregation index, percentage of uninsured individuals, and COVID-19 AAMRs for 2020.

Conclusions: From 2019 to 2020, there was a significant decline in the HMA across a large sample of US counties. Addressing the related county-level factors may mitigate the impact of future health crises on Hispanic populations.