key: cord-0761716-l7jvbh0d authors: Schultes, O.; Lind, M. L.; Brockmeyer, J.; Sosensky, P.; Cummings, D. A. T.; Ko, A. I. title: Closing the health inequity gap during the pandemic: COVID-19 mortality among racial and ethnic groups in Connecticut, March 2020 to December 2021 date: 2022-02-21 journal: nan DOI: 10.1101/2022.02.18.22270820 sha: 5f36a1c40f66bc32e13c7b494dbed751d052056a doc_id: 761716 cord_uid: l7jvbh0d COVID-19 has disproportionally burdened racial and ethnic minority groups within the United States. Leveraging statewide data, we examined the evolution of racial and ethnic disparities in COVID-19 related deaths among Connecticut residents residing in non-congregate settings over three periods of the COVID-19 pandemic. Despite observing large disparities in the age-adjusted mortality rates between Hispanics, non-Hispanic Blacks, and non-Hispanic Whites during the initial pandemic period (March to August 2020), we observed meaningful reductions in the disparities during the subsequent periods (August 2020 to July 2021; July to mid December 2021). Further, during the third period, we failed to find a significant difference in age-adjusted mortality between non-Hispanic Blacks and non-Hispanic Whites. These findings provide evidence that attenuation of racial and ethnic disparities in COVID-19 related outcomes are achievable. Significant racial and ethnic disparities in COVID-19 outcomes have been documented in the US. [1] [2] [3] [4] [5] However, state and national level findings have been mostly based on aggregated data of populations residing in congregate and non-congregate settings. [1] [2] [3] [4] [5] This approach may underestimate outcome disparities in community settings, especially in states that experienced a large COVID-19 burden in nursing homes. 5 Herein, we identified COVID-19-related deaths associated with congregate and non-congregate residential settings in Connecticut and characterized the evolution of racial and ethnic disparities in COVID-19-related mortality among populations residing in non-congregate settings. We retrospectively identified COVID-19-related deaths reported between March 1 st 2020 and December 13 th 2021 from the Connecticut Electronic Disease Surveillance System and determined residential status according to recorded address (Supplement). 5, 6 For the population residing in non-congregate settings, we estimated age-adjusted mortality for composite race and ethnicity categories (Hispanic, non-Hispanic Black and non-Hispanic White) using 2019 census estimates (Supplement). 5 We estimated age-adjusted mortality rate ratios (MRR) for Hispanic and non-Hispanic Blacks, relative to non-Hispanic Whites, for three periods (March 1, 2020 -August 25, 2020, August 26, 2020 -July 12, 2021 and July 13, 2021 -December 13, 2021; All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Among congregate facility-associated deaths, 5.6% (259), 10.0% (463) and 84.4% (3,908) were Hispanic, non-Hispanic Black and non-Hispanic White, respectively. The characteristics of deaths among residents of non-congregate settings are shown in the Table. Overall, age-adjusted mortality among residents of non-congregate settings was highest for Hispanics (19.6/100,000 population-months), followed by non-Hispanic Blacks (17.3/100,000 population-months) and non-Hispanic Whites (6.4/100,000 population-months). During the 1 st period, non-Hispanic Blacks had a 5.2 (95% confidence interval [CI], 4.5-5.9) times higher mortality than non-Hispanic Whites. However, during the 3 rd period, the disparity decreased by Table) . All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 21, 2022. ; https://doi.org/10.1101/2022.02.18.22270820 doi: medRxiv preprint During the initial pandemic period, we found COVID-19 mortality to be nearly five and four times greater for non-Hispanic Black and Hispanic than non-Hispanic White Connecticut residents residing in non-congregate settings. The high magnitude of these disparities compared with those reported during similar periods from other US regions (MRR 1.2-4.0) 1,2,4,5 indicates that the disaggregation of congregate-facility events may reveal levels of disparity not previously appreciated. Our findings suggest that attenuation of racial and ethnic disparities is an achievable public health goal. We observed a decline in disparities in COVID-19-related mortality, as found in prior studies. 1,3 . While we found no significant difference in the COVID-19-related mortality between non-Hispanic Blacks and non-Hispanic Whites during the 3 rd pandemic period, significant disparities remained between Hispanics and non-Hispanic Whites. The limitations of our analysis include the use of a COVID-19-related death endpoint and the potential for misclassification of race, ethnicity and residency status. Further investigations are needed to disentangle the role interventions, such as social protection programs, testing and vaccination, had on reducing disparities in COVID-19 mortality, which may inform effective, generalizable policies targeting the health equity challenge posed by the pandemic. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Population Denominators: We used total Connecticut population data from the 2019 US Census estimates then calculated age-adjusted rates for composite race and ethnic groups among noncongregate residence settings. 1 We did not subtract counts for the population residing in congregate facilities from the denominators, since age, race and ethnicity stratified data is not available for this population. However, these estimates of age-adjusted rates are a reasonable approximation since congregate residential populations account for approximately 1% of the Connecticut population. Changes in COVID-19-Associated Deaths During a Year Among Blacks and Hispanics Compared to Whites in the State of Connecticut. J Racial Ethn Health Disparities Racial disparities in COVID-19 pandemic cases, hospitalisations, and deaths: A systematic review and meta-analysis A longitudinal study of convergence between Black and White COVID-19 mortality: A county fixed effects approach Racial and Ethnic Disparities in COVID-19-Related Infections, Hospitalizations, and Deaths Connecticut COVID-19 Mortality: Demographic Comparisons and Disparities Annual County Resident Population Estimates by Age, Sex, Race, and Hispanic Origin Pandemic Period Definition: We defined pandemic periods based on the lowest 7-day rolling average of daily deaths (nadir) between three large COVID-19 epidemic waves in Connecticut. The three waves occurred in the spring of 2020, fall of 2020 through spring of 2021, and fall of 2021 through the end of the study period All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint this version posted February 21, 2022. ; https://doi.org/10.1101/2022.02.18.22270820 doi: medRxiv preprint