Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID‐19 pandemic

OBJECTIVE: The COVID-19 pandemic has disproportionately affected racial and ethnic minorities among the general population in the United States;however, little is known regarding its impact on Veterans. In this study, our objectives were to identify the extent to which Veterans experienced increased all-cause mortality during the COVID-19 pandemic, stratified by race and ethnicity. DATA SOURCES: Administrative data from the Veterans Health Administration's Corporate Data Warehouse. STUDY DESIGN: We use pre-pandemic data to estimate mortality risk models using five-fold cross-validation and quasi-Poisson regression. Models were stratified by a combined race-ethnicity variable and included controls for major comorbidities, demographic characteristics, and county fixed effects. DATA COLLECTION: We queried data for all Veterans residing in the 50 states plus Washington D.C. during 2016-2020. Veterans were excluded from analysis if they were missing county of residence or race-ethnicity data. Data were then aggregated to the county-year level and were stratified by race-ethnicity. PRINCIPAL FINDINGS: Overall, Veterans' mortality rates were 16.2% above normal during March-December 2020 which equates to 42,348 excess deaths. However, there was substantial variation by racial and ethnic group. Non-Hispanic White Veterans had the lowest rate of excess mortality (17%, 95% CI 11% to 24%), while Native American Veterans had the highest excess mortality (40%, 95% CI 17% to 73%). Black Veterans (32%, 95% CI 27% to 39%) and Hispanic Veterans (26%, 95% CI 17% to 36%) had somewhat lower excess mortality, although these rates were significantly higher compared to White Veterans. Disparities were smaller than in the general population. CONCLUSIONS: Minoritized Veterans experienced higher rates excess mortality during the COVID-19 pandemic compared to White Veterans, though with smaller differences than the general population. This is likely due in part to the long-standing history of structural racism in the United States that has negatively affected the health of minoritized communities via several pathways including health care access, economic, and occupational inequities. This article is protected by copyright. All rights reserved.