Leading Causes of Death Among Adults Aged 25 to 44 Years by Race and Ethnicity in Texas During the COVID-19 Pandemic, March to December 2020 | Health Disparities | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Sign In
Figure.  Cause-Specific Mortality Among Texas Residents Aged 25 to 44 Years, January 2017 Through December 2020
Cause-Specific Mortality Among Texas Residents Aged 25 to 44 Years, January 2017 Through December 2020

The solid lines indicate raw cause-specific death counts for usual leading causes of death from January 2017 through December 2020. The dotted dark blue lines indicate raw COVID-19–attributed death counts from March through December 2020.

Table.  All-Cause Deaths, Excess Deaths, and Disease-Specific Causes of Death in Texas Residents Aged 25 to 24 Years by Race and Ethnicity, March 1 to December 31, 2020
All-Cause Deaths, Excess Deaths, and Disease-Specific Causes of Death in Texas Residents Aged 25 to 24 Years by Race and Ethnicity, March 1 to December 31, 2020
1.
Rossen  LM, Branum  AM, Ahmad  FB, Sutton  P, Anderson  RN.  Excess deaths associated with COVID-19, by age and race and ethnicity—United States, January 26–October 3, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(42):1522-1527. doi:10.15585/mmwr.mm6942e2PubMedGoogle ScholarCrossref
2.
Simon  P, Ho  A, Shah  MD, Shetgiri  R.  Trends in mortality from COVID-19 and other leading causes of death among Latino vs White individuals in Los Angeles County, 2011-2020.   JAMA. 2021;326(10):973-974. doi:10.1001/jama.2021.11945 PubMedGoogle ScholarCrossref
3.
Faust  JS, Krumholz  HM, Du  C,  et al.  All-cause excess mortality and COVID-19–related mortality among US adults aged 25-44 years, March-July 2020.   JAMA. 2021;325(8):785-787. doi:10.1001/jama.2020.24243 PubMedGoogle ScholarCrossref
4.
National Center for Health Statistics. Weekly counts of deaths by jurisdiction and age. Centers for Disease Control and Prevention. Updated October 13, 2021. Accessed October 18, 2021. https://data.cdc.gov/NCHS/Weekly-Counts-of-Deaths-by-Jurisdiction-and-Age/y5bj-9g5w
5.
Chen  Y-H, Glymour  MM, Catalano  R,  et al.  Excess mortality in California during the coronavirus disease 2019 pandemic, March to August 2020.   JAMA Intern Med. 2021;181(5):705-707. doi:10.1001/jamainternmed.2020.7578 PubMedGoogle ScholarCrossref
6.
Chen  Y-H, Glymour  M, Riley  A,  et al.  Excess mortality associated with the COVID-19 pandemic among Californians 18-65 years of age, by occupational sector and occupation: March through November 2020.   PLoS One. 2021;16(6):e0252454. doi:10.1371/journal.pone.0252454 PubMedGoogle Scholar
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Views 10,271
    Citations 0
    Research Letter
    November 22, 2021

    Leading Causes of Death Among Adults Aged 25 to 44 Years by Race and Ethnicity in Texas During the COVID-19 Pandemic, March to December 2020

    Author Affiliations
    • 1Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
    • 2Harvard University, Cambridge, Massachusetts
    • 3Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
    • 4Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut
    • 5Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
    JAMA Intern Med. Published online November 22, 2021. doi:10.1001/jamainternmed.2021.6734

    In the United States, adults aged 25 to 44 years had the largest relative increase in all-cause mortality during the COVID-19 pandemic in 2020, with disproportionate increases among Black, Hispanic, and Latino adults.1,2 In the first 6 months of the pandemic, the number of COVID-19–attributed deaths among people aged 25 to 44 years in regions with major outbreaks was similar to or exceeded the number to deaths from drug overdoses, which has been the usual leading cause of death in this age group in prior years.3 To better understand excess mortality among adults aged 25 to 44 years during the early months of the COVID-19 pandemic, we examined mortality data from Texas, a racially and ethnically diverse state.

    Methods

    Using records from the Texas Department of State Health Services, we obtained monthly mortality data (stratified by race and ethnicity [Hispanic, non-Hispanic Black, and non-Hispanic White]) among adults aged 25 to 44 years residing in Texas for the 6 leading causes of death (2015-2020) and COVID-19 (March-December 2020).4 The 6 leading causes of death were accidents (excluding unintentional overdoses), malignant neoplasms, diseases of the heart, intentional self-harm, assault (homicide), and unintentional overdoses (see eAppendix in the Supplement for diagnosis codes). To estimate 2020 population data, we used Centers for Disease Control and Prevention data for 2015 through 2019 and autoregressive integrated moving averaging as previously reported.3 We calculated incident mortality rates and corresponding 95% CIs for cause-specific mortality. For each racial and ethnic group, the cause of death with the greatest incident rate was considered the leading cause, as well as any other cause whose 95% CI overlapped with the 95% CI of the leading cause. Statistical analyses were performed in R, version 4.0.2 (R Foundation for Statistical Computing). The Texas Department of State Health Services’ Center for Health Statistics, per institutional policy, exempted the study from institutional review board approval.

    Results

    Among Black, Hispanic, and White persons aged 25 to 44 years residing in Texas during March through December 2020, COVID-19 was the leading cause of death during the third quarter of 2020 and the second leading cause during the fourth quarter (Figure, A and Table). During July, November, and December, COVID-19 was the numeric leading cause of death in this combined group (Table). The leading cause of death for March through December 2020 was accidents (Figure, A).

    Among Black individuals aged 25 to 44 years, COVID-19 was the sixth leading cause of death from March through December 2020 (Figure, B), though in July COVID-19 was numerically the leading cause of death (Table). The leading causes of death were assault, diseases of the heart, and accidents (Figure, B and Table).

    Among Hispanic individuals aged 25 to 44 years, COVID-19 was the leading cause of death from March through December 2020 (Figure, C and Table) and during the third and fourth quarters of 2020. During the third quarter, more COVID-19–attributed deaths were recorded among Hispanic individuals aged 25 to 44 years than for the next 2 most-common causes combined (accidents and unintentional overdoses).

    Among White individuals aged 25 to 44 years, COVID-19 was the sixth leading cause from March through December 2020 (Figure, D). The leading causes of death were unintentional overdoses and accidents (Figure, D and Table).

    Discussion

    Results of this cohort study demonstrated that during March through December 2020, the first 10 months of the COVID-19 pandemic in the US, COVID-19 was the second leading cause of death among Black, Hispanic, and White residents of Texas aged 25 to 44 years, and the most common cause during the third quarter of 2020, with a markedly disproportionate increase in mortality among Hispanic residents. One possible explanation may be that Hispanic persons were more likely to be essential workers and, therefore, were less able to avoid exposure to SARS-CoV-2, which has previously been linked to socioeconomic factors.5,6 Another possible explanation is that Hispanic residents were less likely to have access to primary care and, therefore, more likely to experience unmanaged medical comorbidities associated with worse COVID-19 outcomes. Limitations of this study include the accuracy of data from death certificates and the preliminary nature of 2020 data. Nevertheless, these findings highlight the markedly disparate effects of the COVID-19 pandemic in different populations of young adults, particularly among Hispanic residents of Texas.

    Back to top
    Article Information

    Accepted for Publication: September 30, 2021.

    Published Online: November 22, 2021. doi:10.1001/jamainternmed.2021.6734

    Corresponding Author: Jeremy Samuel Faust, MD, MS, Department of Emergency Medicine, Brigham and Women’s Hospital, 10 Vining St, Boston, MA 02115 (jsfaust@gmail.com).

    Author Contributions: Dr Faust had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Faust, Nguemeni Tiako, Barnett.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Faust, Nguemeni Tiako.

    Critical revision of the manuscript for important intellectual content: Faust, Chen, Du, Li, Krumholz, Barnett.

    Statistical analysis: Faust, Nguemeni Tiako, Li, Barnett.

    Administrative, technical, or material support: Chen.

    Supervision: Li, Barnett.

    Conflict of Interest Disclosures: Dr Krumholz reports expenses and/or personal fees from UnitedHealth, IBM Watson Health, Element Science, Aetna, Facebook, Siegfried & Jensen law firm, Arnold & Porter law firm, Martin/Baughman law firm, F-Prime Capital, and the National Center for Cardiovascular Diseases in Beijing, China; owns Refactor Health and Hugo Health; and has grants and/or contracts from the Centers for Medicare & Medicaid Services, Medtronic, the US Food and Drug Administration, Johnson & Johnson, Foundation for a Smoke-Free World, the Connecticut Department of Public Health, and the Shenzhen Center for Health Information. Dr Barnett reports being retained as an expert witness by government plaintiffs in lawsuits against opioid manufacturers. No other disclosures were reported.

    Additional Contributions: We thank the Center for Health Statistics’ Vital Events Data Management program of the Texas Department of State Health Services for helpfully providing data. There was no compensation for the contribution.

    References
    1.
    Rossen  LM, Branum  AM, Ahmad  FB, Sutton  P, Anderson  RN.  Excess deaths associated with COVID-19, by age and race and ethnicity—United States, January 26–October 3, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(42):1522-1527. doi:10.15585/mmwr.mm6942e2PubMedGoogle ScholarCrossref
    2.
    Simon  P, Ho  A, Shah  MD, Shetgiri  R.  Trends in mortality from COVID-19 and other leading causes of death among Latino vs White individuals in Los Angeles County, 2011-2020.   JAMA. 2021;326(10):973-974. doi:10.1001/jama.2021.11945 PubMedGoogle ScholarCrossref
    3.
    Faust  JS, Krumholz  HM, Du  C,  et al.  All-cause excess mortality and COVID-19–related mortality among US adults aged 25-44 years, March-July 2020.   JAMA. 2021;325(8):785-787. doi:10.1001/jama.2020.24243 PubMedGoogle ScholarCrossref
    4.
    National Center for Health Statistics. Weekly counts of deaths by jurisdiction and age. Centers for Disease Control and Prevention. Updated October 13, 2021. Accessed October 18, 2021. https://data.cdc.gov/NCHS/Weekly-Counts-of-Deaths-by-Jurisdiction-and-Age/y5bj-9g5w
    5.
    Chen  Y-H, Glymour  MM, Catalano  R,  et al.  Excess mortality in California during the coronavirus disease 2019 pandemic, March to August 2020.   JAMA Intern Med. 2021;181(5):705-707. doi:10.1001/jamainternmed.2020.7578 PubMedGoogle ScholarCrossref
    6.
    Chen  Y-H, Glymour  M, Riley  A,  et al.  Excess mortality associated with the COVID-19 pandemic among Californians 18-65 years of age, by occupational sector and occupation: March through November 2020.   PLoS One. 2021;16(6):e0252454. doi:10.1371/journal.pone.0252454 PubMedGoogle Scholar
    ×