Skip to main content
NCBI home page
SAGE - PMC COVID-19 Collection logoLink to SAGE - PMC COVID-19 Collection
. 2023 May 17:08982643231174980. doi: 10.1177/08982643231174980

Latino Mortality Paradox Found (Again): COVID-19 Mortality a Tale of Two Years

Marc A Garcia 1,✉, Rogelio Sáenz 2
PMCID: PMC10195697  PMID: 37196251

Abstract

Objectives

This study examines the resiliency of the Latino Mortality paradox during the COVID-19 pandemic.

Methods

Data from the Centers for Disease Control and Prevention are used to compute the ratio of Latino-to-white all-causes death rates for adults aged 45 and older, nationally and among 13 U.S. states with Latino populations greater than one million.

Results

Nationally, the Latino mortality paradox persisted in 2020 and 2021. However, there was significant variation across states. We document three distinct patterns of COVID-19 mortality across 13 U.S. states: 1) the disappearance of the Latino mortality paradox, 2) the persistence of the Latino mortality paradox, and 3) the disappearance in 2020 and reemergence in 2021 of the Latino mortality paradox.

Discussion

COVID-19 Mortality has disproportionately affected mid- and late-life Latinos, although the disparities relative to whites have narrowed. We discuss the dynamics influencing the waning and waxing of the Latino mortality paradox.

Keywords: coronavirus, latino mortality paradox

Introduction

As the coronavirus COVID-19 pandemic continues to evolve and remain a significant public health concern, researchers and policymakers have gained a better understanding of who among the nation’s population is most at risk for infection, hospitalization, and mortality stemming from the SARS-CoV-2 virus (APM Research Lab, 2022; Mackey et al., 2021; Marlow et al., 2022; Wiltz et al., 2022; Yek et al., 2022). While all segments of the population have been impacted, emerging research indicates that the burden of COVID-19 mortality has been disproportionate for the U.S. Latino population (Aburto et al., 2022; Aschmann et al., 2022; Garcia, Homan, García, & Brown, 2021; Luck et al., 2022; Sáenz & Garcia, 2021; Truman et al., 2022). The latest cumulative COVID-19 age-adjusted death data show that between January 1, 2020, and November 19, 2022, Latinos have died at a rate 1.6 times higher than whites. (CDC, 2022b).

The magnitude of Latino-white COVID-19 mortality disparities has drawn renewed attention to decades of research that has investigated the “Latino mortality paradox,” the finding that Latinos residing in the United States have lower mortality rates than non-Latino whites despite their lower levels of education, income, and wealth (Arias et al., 2020; Lariscy et al., 2015; Markides & Eschbach, 2005, 2011). This finding has proven “paradoxical” given the long-standing literature documenting a robust negative association between socioeconomic status and mortality (Hummer & Hernandez, 2013; Turra & Goldman, 2007). However, recent evidence suggests that the ongoing COVID-19 pandemic has shifted historical Latino-white mortality patterns leading to a “diminishing” of the Latino mortality paradox (Aburto et al., 2022; Andrasfay & Goldman, 2020; Arias, Tejada-Vera, Kochanek, & Ahmad, 2022; Aschmann et al., 2022; Do & Frank, 2021; Garcia, Homan, et al., 2021; Sáenz & Garcia, 2021).

Nationally, Latino-white COVID-19 mortality disparities early in the pandemic were attributed, in part, to a host of factors including: “preexisting medical conditions” such as cardiovascular disease, diabetes, and obesity; occupational exposure in industries deemed “essential”; lack of access to quality and culturally appropriate healthcare; and residential segregation and multigenerational households (Garcia, Homan, García, & Brown, 2021; Goldman et al., 2021; Rho et al., 2020; Riley et al., 2021). Although these conditions make people more susceptible to infection and death, they do not fully account for the stark Latino-white COVID-19 mortality disparities observed in Latino communities. Indeed, COVID-19 mortality data for 2021 suggest that there have been significant shifts in all-causes mortality between Latinos and whites, possibly leading to the reemergence of the Latino paradox (Arias et al., 2022; Aschmann et al., 2022; Truman et al., 2022). These trends point to the resilience of the Latino population, after sustaining the highest levels of COVID-19 infection and mortality in the first year of the pandemic.

Mounting research has examined variation among U.S. Latinos in COVID-19 mortality by census regions, individual states, counties, and metro/non-metro areas (Do & Frank, 2021; Horner et al., 2022; Lundberg et al., 2022; Riley et al., 2021; Riley et al., 2022; Rodriguez-Diaz et al., 2020). However, it is unclear how these patterns have changed since the beginning of the pandemic, and whether national trends in COVID-19 mortality are reflected across U.S. states with the largest Latino populations. Thus, this study aims to assess how pandemic-related shifts by time periods (i.e., calendar years for 2020 and 2021) in COVID-19 mortality have taken an unprecedented toll on Latino communities and upended the long-standing Latino mortality advantage.

The Devastation of COVID-19 in the Latino Community and Subsequent Resilience

As the largest minority group in the United States, Latinos comprise 18.9% (62.5 million) of the population (US Census Bureau, 2021); yet as of November 23, 2022, Latinos accounted for 24.7% (14.9 million) of reported COVID-19 cases and over 166,000 COVID-19 deaths (CDC, 2022a). In addition to high COVID-19 infection and mortality rates, Latinos (particularly older adults), have experienced greater pandemic-related job and wage loss than whites (Davis et al., 2020; Goldman et al., 2021). Research shows pandemic-related financial hardship (i.e., job loss, unpaid leave due to illness, and decreased household income) resulted in reduced access to basic necessities and preventive healthcare services (Garcia, Thierry, & Pendergrast, 2022) that are protective of health and reduce the risk of mortality. Insufficient economic resources were also likely to prevent Latinos from purchasing personal protective equipment or services that reduce the risk of COVID-19 exposure. This is particularly noteworthy as many older Latinos who experienced financial hardship continued to work in “essential” occupations out of necessity, where the risk of exposure to contracting the disease and succumbing to COVID-19 mortality is relatively high (Klein & Smith, 2021; Sáenz et al., 2021).

The combination of high rates of COVID-19 infection and mortality, employment disruption, income loss, and pre-pandemic inequalities in health and wealth has resulted in compounding crises that have disproportionately impacted Latinos. Despite the personal and economic toll, Latino communities have shown resiliency in their response to the devastating loss of life during the pandemic. Evidence of resiliency is evident in the rising vaccination rates among Latinos. The latest vaccination data from the Kaiser Family Foundation (Ndugga, Pham, et al., 2022) indicate that over the initial course of the vaccination rollout, Latinos were less likely than whites to receive a vaccine; however, Latino-white disparities in COVID-19 vaccinations have reversed over time with 67% of Latinos reporting at least one dose compared to 64% of whites. Latinos have also been shown to exhibit higher vaccination rates than whites in 22 of the 39 states that provide vaccination data for Latinos (Ndugga, Pham, et al., 2022). For example, Latino vaccination rates surpass those of whites in Alabama, the District of Columbia, Florida, Georgia, Indiana, Kansas, Louisiana, Maryland, Michigan, Mississippi, Nevada, New Hampshire, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Vermont, Virginia, and Washington. The rising vaccination rates among Latinos could potentially have contributed to shifts in COVID-19 mortality that resulted in the reemergence of the Latino mortality paradox.

Beyond resiliency in response to challenges related to the ongoing pandemic, emerging evidence shows that although the older U.S. Latino population exhibits a lower risk of mortality than whites (i.e., the Latino mortality paradox), their extended years of life are characterized by a high burden of disease that negatively impacts the quality of life at older ages. That is, although Latinos exhibit a mortality advantage vis-a-vis whites, they are disadvantaged in terms of the number of late-life years spent with morbidity (Cantu et al., 2013; Garcia, Garcia, Chiu, Raji, & Markides, 2018a), functional limitations (Garcia, Reyes, García, Chiu, & Macias, 2020), disability (Hayward et al., 2014), and dementia (Garcia, Downer, et al., 2021; Garcia et al., 2019; Garcia, Tarraf, Reyes, & Chiu, 2022). This evidence points to the resilience of the older Latino population in terms of longevity with a high burden of disease. However, it remains unclear whether COVID-19 infections will impact the resiliency the Latino population has shown to live with the disease.

Mortality in the Context of U.S. States

There is strong evidence that U.S. state policy contexts are crucial to understanding mortality variations in mortality patterns over the last several decades (Montez et al., 2019, 2022). For example, research shows that states vary in policies, resources, and opportunity structures in ways that affect population health (Montez et al., 2020). In addition, recent evidence indicates that states with more liberal or progressive politics are associated with lower mortality and more favorable gains in life expectancy over the last several decades compared to states with more conservative politics (Montez & Farina, 2021; Montez et al., 2022). The state context is particularly important in the understanding of COVID-19 disparities in mortality levels. Indeed, from the outset of the pandemic, solidly Republican states have emphasized personal freedom over the establishment of mask mandates and lockdowns and whites in these states have disproportionately rejected COVID-19 vaccinations. One of the consequences of such state variations is that the COVID-19 death rates between people of color and whites narrowed between 2020 and 2021 with nearly all states experiencing significant gains in white COVID-19 age-adjusted death rates between 2020 and 2021 (Sáenz et al., 2022). The focus on state variations in policies, resources, and opportunity structures related to health and morality is also of utility in understanding the dynamics associated with the Latino mortality paradox, particularly with regards to the impact of COVID-19 on overall mortality.

As COVID-19 becomes a leading cause of death in the U.S., the magnitude and scale of the pandemic become increasingly evident for Latino communities. The current study uses national data to build on recent work in COVID-19 mortality to document variation due to period shifts in Latino-white COVID-19 mortality both nationally and among 13 U.S. states with the largest Latino populations. We restrict our analyses to adults aged 45 and older to further contextualize variation in COVID-19 mortality among mid- and late-life adults, age groups where findings for the Latino mortality paradox have been the most robust (Fenelon et al., 2017).

Methods

Data from the Centers for Disease Control and Prevention (CDC) Provisional COVID-19 Deaths by Race and Hispanic-Origin Race are used to conduct the analysis. The CDC releases COVID-19 cumulative deaths each week for this configuration of characteristic breakdowns for the United States and each of the states including the District of Columbia.

In our analysis, we obtain cumulative counts of COVID-19 deaths for 2020 and 2021 by race and Hispanic-origin and death. Data for 2020 are based on the last week of data for 2020 (week ending on December 20–December 26, 2020). The data for 2021 are obtained by subtracting the cumulative COVID-19 deaths in the final week of 2021 (week ending on December 19–December 25, 2021) from that for the final week of 2020 (week ending December 20–December 26, 2020). The data analysis presented below consists of data for five age groups: 45–54, 55–64, 65–74, 75–84, and 85+. These five age categories allow us to obtain a portrait of the life course that spans mid-life to late-life for the two-year period of interest.

The analysis is further restricted to Latinos and non-Hispanic whites (herein referred to as “white”) in these five age groups to obtain age-specific data rates for COVID-19 deaths, non-COVID-19 deaths, and all-causes deaths. For each of the three types of causes of death for Latinos and whites, we compute age-specific death rates based on the following formulas:

COVID‐19 Age‐Specific Death Rateijk=(COVID‐19 deathsijk/Populationijk) * 100,000
Non‐COVID‐19 Age‐Specific Death Rateijk=(Non‐COVID‐19 deathsijk/Populationijk) * 100,000
All−Causes Age−Specific Death Rateijk=(All−causes deathsijk/Populationijk) * 100,000

where i represents year (2020 or 2021), j race/ethnic group (Latino or white), and k represents an age group (45–54, 55–64, 65–74, 75–84, and 85+). Because there is a lag between deaths in a given year and population estimates, the age-specific death rates for 2020 are based on the age-specific population estimates for 2019, and those for 2021 are based on the estimates for 2020.

The three causes of death allow us to gauge mortality differences at two points in time (2020 and 2021) between Latinos and whites based on COVID-19 deaths, non-COVID-19 deaths (i.e., the scenario without COVID-19 deaths, as was the case in the pre-pandemic period), and all-causes of deaths that allows us to assess whether the Latino paradox persisted in each of the two years. To compare the gaps in death rates between Latinos and whites across the three causes of death and age groups, we compute the ratio of the Latino age-specific death rates to those of whites for 2020 and 2021.

The age-specific death rates are computed for the United States and the 13 states with more than 1 million Latinos based on the 2020 census. The inclusion of the 13 states ensures that the age-specific death rates are stable with age-specific populations that are large and that we gain an understanding of these variations across the country. Given that the CDC does not report the number of COVID-19 deaths for age categories in racial/ethnic groups when the deaths are less than 10, states with smaller Latino populations are more likely than the 13 states used here to not have complete COVID-19 enumerations.

Finally, to get an overall assessment of the all-causes Latino mortality paradox before the pandemic and in the two full years of the pandemic, we compute the all-causes Age-Adjusted Death Rates (AADR) for the population aged 45 and older for seven time periods (2015–2019, 2020, and 2021) in which we apply the all-causes death rates of Latinos and whites to a standard population (the overall U.S. population in 2019). These AADRs represent the number of deaths from all causes per 100,000 persons. Subsequently, the ratios for Latino-to-white AADR’s for the population 45 and older for seven years are computed to determine the extent to which the Latino mortality paradox has shifted over this period. The 2015–2019 all-causes rates are obtained from the CDC Wonder (Centers for Disease Control and Prevention, 2022b) and are used to compute the all-causes AADR in the 2015–2019 five-year period prior to the pandemic. We compare the all-causes AADR for 2015–2019 to 2020 and 2021 and assess the Latino-to-white AADRs for each of the three periods.

Results

We first examine the disparities in death rates between Latinos and whites for COVID-19 deaths, non-COVID-19 deaths, and all-causes of death. This analysis will help us detect changes and stability in the gaps in these three causes of death between 2020 and 2021.

COVID-19 Deaths

There is much evidence that Latinos have died from COVID-19 at disproportionately higher rates compared to whites. Table 1 shows the ratios of Latino-to-white COVID-19 death rates for 2020 and 2021. In the United States, across all ages and both years, Latinos have died from COVID-19 at higher rates than whites. There are two general patterns at the national level. First, in general, the Latino-white disparities narrow from younger ages to older ages in 2020 and 2021. Second, the Latino-white COVID-19 gaps have diminished noticeably across all age groups between 2020 and 2021. However, Latinos between the ages of 45 and 74 continue to exhibit COVID-19 mortality rates that were twice as high as those of whites in 2021.

Table 1.

Ratio of Latino-To-White COVID-19 Age-specific Death Rates in the U.S. And Thirteen States With More Than 1 Million Latinos, 2020 and 2021.

45–54 55–64 65–74 75–84 85+
Geographic areas 2020 2021 2020 2021 2020 2021 2020 2021 2020 2021
United States 5.61 1.94 4.68 2.12 3.52 2.09 2.19 1.61 1.33 1.10
Arizona 6.00 2.55 5.03 2.78 4.72 2.73 3.17 2.12 2.27 1.67
California 6.95 3.77 6.29 3.69 5.48 3.90 3.08 2.67 2.04 1.56
Colorado 6.25 2.81 6.52 2.65 4.33 2.91 2.59 2.14 1.93 1.54
Florida 2.56 1.01 2.75 1.22 2.57 1.44 2.16 1.40 1.77 1.26
Georgia 4.96 .95 3.23 .96 2.64 1.10 1.38 1.14 .80 .73
Illinois 7.83 2.27 6.47 2.10 3.74 1.95 2.32 1.38 1.33 .91
New Jersey 6.26 2.03 4.43 2.35 3.11 2.25 2.16 1.47 1.27 1.14
New Mexico 2.36 2.34 4.10 1.96 3.32 2.33 1.82 2.04 1.18 1.30
New York 7.26 1.73 5.45 1.81 4.14 1.66 2.84 1.23 1.69 .75
North Carolina 9.20 1.26 7.68 1.61 5.50 1.30 2.10 1.15 1.09 .57
Pennsylvania 1.07 .97 1.06 .93 1.07 .95 1.01 .86 .69 .58
Texas 4.88 1.81 5.00 1.89 4.47 1.86 2.75 1.52 1.94 1.09
Washington .87 .84 .89 .83 .99 .95 .94 .80 .69 .66
Open in a new tab

Source: Centers for disease Control and Prevention (2022). Authors' calculations.

Overall, the 13 states tend to reflect the national gaps in COVID-19 death rates across the two time periods (Table 1). However, there are several significant exceptions. First, in the state of Washington, whites exhibited higher COVID-19 death rates compared to Latinos in both 2020 and 2021 across the five age groups and these gaps slightly increased over the last year. Second, in Pennsylvania, whites held a slight advantage with lower COVID-19 death rates between the ages of 45 and 84 in 2020, but whites age 85+ exhibited higher COVID-19 mortality than Latinos in 2020. By 2021, Latinos had lower COVID-19 death rates than whites across all five age groups. For instance, Latino Pennsylvanians 85+ died from COVID-19 at a rate 42% lower than their white counterparts. Third, in Georgia, whites 85+ had a higher COVID-19 death rate in 2020 than Latinos, a pattern that continued into 2021. In addition, whites between the ages of 45 and 64 experienced a higher COVID-19 mortality rate than Latinos in 2021, further highlighting the shifting patterns of COVID-19 mortality among younger age groups. Finally, our results indicate that although whites 85+ exhibited lower COVID-19 death rates compared to Latinos in 2020 in Illinois, New York, and North Carolina, these patterns reversed in 2021 with whites exhibiting higher COVID-19 mortality rates than Latinos.

In contrast to the favorable COVID-19 Latino mortality rates compared to those of whites in Washington, Pennsylvania, Georgia, Illinois, New York, and North Carolina, three southwestern states—Arizona, California, and Colorado—continued to fare much worse than whites across the five age groups. The Latino-white COVID-19 death rate gap was greatest across all 13 states in California between the ages of 45 and 84, with the ratio gap being between 2.7 (age group 75–84) and 3.90 (65–74).

Non-COVID-19 Deaths

We now turn our attention to non-COVID-19 deaths. This represents the what-if-COVID-19-had-not-occurred scenario. At the national level, the results show that for non-COVID-19 deaths, Latinos had significantly lower death rates than whites across all age categories in both 2020 and 2021 (Table 2). The gaps were stable across both years. In 2021, Latinos died from non-COVID-19 deaths at rates ranging from 23% lower among adults 65–74 years old to 31% lower among those in the 45–54 age group.

Table 2.

Ratio of Latino-To-White Non-COVID-19 Age-specific Death Rates in the U.S. And Thirteen States With More Than 1 Million Latinos, 2020 and 2021.

45–54 55–64 65–74 75–84 85+
Geographic areas 2020 2021 2020 2021 2020 2021 2020 2021 2020 2021
United States .70 .69 .74 .73 .79 .77 .79 .76 .75 .72
Arizona .81 .83 .88 .88 .93 1.02 1.01 .98 .97 .95
California .83 .84 .84 .84 .88 .88 .83 .85 .77 .75
Colorado 1.15 1.25 1.23 1.22 1.15 1.20 1.07 .97 .90 .92
Florida .44 .42 .52 .53 .71 .68 .85 .86 .94 .93
Georgia .51 .41 .43 .42 .51 .53 .62 .52 .42 .47
Illinois .73 .72 .74 .74 .72 .68 .73 .69 .59 .60
New Jersey .86 .81 .87 .72 .75 .69 .80 .73 .69 .59
New Mexico .99 1.09 1.09 1.08 1.04 1.00 1.02 .98 .96 .94
New York .96 .89 .93 .90 .85 .80 .82 .76 .75 .65
North Carolina .37 .52 .53 .49 .62 .55 .55 .66 .51 .46
Pennsylvania .94 .93 .92 .87 .89 .87 .87 .79 .65 .56
Texas .75 .78 .81 .80 .86 .83 .84 .82 .80 .77
Washington .76 .70 .71 .71 .81 .78 .78 .70 .61 .63
Open in a new tab

Source: Centers for disease Control and Prevention (2022). Authors' calculations.

The persistence of the Latino paradox among non-COVID-19 deaths was generally consistent across almost all 13 states with three exceptions (Table 2). The three exceptions occurred in three southwestern states—Colorado, New Mexico, and Arizona. In Colorado, Latinos had higher non-COVID-19 deaths rates in four age groups (45–54, 55–64, 65–74, and 75–84) in 2020, and three age groups (45–54, 55–64, and 65–74) in 2021. In New Mexico, Latinos had higher death rates than whites in three age groups (55–64, 65–74, and 75–84) in 2020 and two age groups (45–54 and 55–64) in 2021. In Arizona, Latinos in the 75–84 age category had a slightly higher death rate than whites in 2020, a pattern observed among Latinos in the 65–74 age group in 2021. However, it is important to note that these three southwestern states exhibited a weak Latino mortality paradox before the pandemic. For instance, in Colorado, during the 2015–2019 period, Latinos had higher age-specific death rates than whites for all causes in three age groups 45 and older (45–54, 55–64, and 65–74) and nearly the identical rate in the 75–84 age category. In Nex Mexico, Latinos had higher death rates than whites in two age groups (55–64 and 65–74) and almost the same in the 45–54 age category. In Arizona, Latinos and whites had a similar death rate in the 75–84 age category. These findings are an important contribution to the growing literature on the impact of COVID-19 mortality on the Latino population as previous research has largely focused on national-level trends with little attention to differences at the state-level. The above results make clear that national-level trends do not necessarily correspond across all states.

Despite these three exceptions, the Latino paradox remained robust with regard to non-COVID-19 deaths across all age categories in the other ten states included in the analysis. Indeed, the Latino mortality advantage over whites was evident in both 2020 and 2021, particularly in the two Latino new-destination states of Georgia and North Carolina where Latinos in 2021 had a non-COVID-19 death rate that was 53% lower than whites in Georgia and 46% lower in North Carolina. According to the 2019 American Community Survey, Georgia (40.1%) and North Carolina (39.7%) are Latino new destination states with relatively high percentages of foreign-born Latinos, which is consistent with the Latino mortality paradox.

All Causes of Death

To get an overall assessment of the Latino mortality paradox before (in 2015–2019) and in the two full years of the pandemic (2021 and 2022), we focus here on the all-causes age-adjusted death rates (AADRs) for the Latino and white populations 45 and older in these three periods spanning seven years—2015–2019 before the pandemic and 2000 and 2021 during the pandemic. Specifically, we examine the ratio of Latino-to-white all-causes AADRs to assess changes in the Latino mortality paradox across this period in the U.S. and 13 states with more than 1 million Latinos.

Overall, prior to the pandemic in the U.S., Latinos 45 and older had an age-adjusted death rate for all-cause mortality that was 30% lower than whites, consistent with the Latino mortality paradox (Figure 1). While research suggested that the Latino mortality paradox was rapidly diminishing from the onset of the pandemic to August 22, 2020 (Sáenz & Garcia, 2020), the all-cause AADRs for the two full years of the pandemic indicate that the paradox reemerged among persons 45 and older, albeit with the Latino advantage being smaller during the pandemic. Nevertheless, while the Latino mortality advantage over whites has not rebounded to the pre-pandemic level, it has increased from a 10% mortality advantage over whites in 2020 to a 14% mortality advantage in 2021, possibly due to many whites, especially among those living in solidly Republican-dominant states, opposing COVID-19 vaccinations (Sáenz & Garcia, 2022).

Figure 1.

Figure 1.

Open in a new tab

U.S. ratio of Latino-to-white age-adjusted death rate for population 45 and older, 2015–2019 to 2021.

However, there is a significant amount of variation in the ratios of Latino-white all-causes AADRs across the 13 states with more than 1 million Latinos (Figure 2). The 13 states can be categorized into four groupings based on the existence or absence of the Latino mortality paradox before the pandemic (2015–2019) and in the full years of the pandemic (2020 and 2021). First, four Southwest states (Arizona, California, Colorado, and New Mexico) experienced higher overall AADRs among Latinos compared to whites in both 2020 and 2021 with the gap tending to increase in 2021. Colorado featured a weak Latino mortality paradox prior to the pandemic with Latinos 45 and older having a death rate that was only 1.5% lower than that of whites in the 2015–2019 period with whites having a widening death advantage over Latinos in 2020 and 2021. The other three southwestern states—Arizona, California, and New Mexico—experienced the loss of the Latino mortality paradox as Latinos lost their mortality advantage in 2020 and 2021 in these three states. In this set of states, the more favorable COVID-19 outcomes of whites are associated with much higher levels of education among whites 25 and older compared to Latinos. According to the 2019 ACS, the ratio of the percentage of white college graduates relative to Latinos stood at 3.15 in California, 2.65 in Colorado, 2.64 in Arizona, and 2.50 in New Mexico. Furthermore, the vaccination rates of Latinos lag significantly behind those of whites in these four states (Arizona: white vaccination rate, 60% vs. Latino vaccination rate, 44%; California: 75% vs. 65%; Colorado: 78% vs. 42%; New Mexico: 75% vs. 59%) (Ndugga, Pham, et al., 2022).

Figure 2.

Figure 2.

Open in a new tab

Ratio of Latino-to-white age-adjusted death rate for population 45 and older in 13 states, 2015–2019 to 2021.

Second, six states located in the South, Northeast, and West (Florida, Georgia, Illinois, North Carolina, Pennsylvania, and Washington) exhibited lower Latino all-causes AADRs among the population 45 and older before the pandemic in 2019 and during the pandemic in 2020 and 2021. Across all of these six states, whites 25 and older had lower than 40% with a bachelor’s degree or higher with the lowest levels in Pennsylvania (33.9%), Florida (34.5%), North Carolina (36.0%), and Georgia (36.5%). Moreover, as findings for the Latino mortality paradox have been particularly robust among immigrants, it is noteworthy that Florida (46.6%), Georgia (40.1%), and North Carolina (39.7%) have the highest share of foreign-born Latinos among the 13 states included in the analysis. In addition, Latinos have higher vaccination rates than whites in four states (Florida, Georgia, North Carolina, and Washington), exhibit comparable vaccination rates as whites in Illinois, and have a lower vaccination rate than whites in Pennsylvania (Ndugga, Pham, et al., 2022).

Third, three states (New Jersey, New York, and Texas) that sustained early surges in COVID-19 disproportionately impacting people of color in 2020 saw the Latino mortality paradox present in 2019, disappearing in 2020, and reappearing in 2021. However, the three states did not arrive there in the same manner. On the one hand, New York and New Jersey, the epicenters of the pandemic in early 2020, saw their Latino all-cause AADRs drop by 17.4% and 15.0% between 2020 and 2021, respectively, while their white AADRs rose by 14.0% and 8.8%, respectively. On the other hand, the Latino mortality paradox reappeared in Texas in part to a faster increase in the white AADR among the population 45 and older (32.2%) between 2020 and 2021 than the increase of Latinos (21.4%). The Latino vaccination rate is 13% points higher than that of whites in New York and 11% points higher in Texas (vaccination data are currently not available for New Jersey) (Ndugga, Pham, et al., 2022).

Conclusions

Consistent with prior research we document stark Latino-white inequalities in COVID-19 mortality (APM Research Lab, 2022; Garcia, Homan, et al., 2021; Mackey et al., 2021; Rodriguez-Diaz et al., 2020; Sáenz & Garcia, 2021). Our findings demonstrate that the COVID-19 pandemic is reshaping Latino-white patterns in mortality. Specifically, we document that Latinos have age-adjusted COVID-19 death rates approximately 1.6 times higher than whites from January 1, 2020, to November 19, 2022. Our results further show that the white COVID-19 mortality advantage over Latinos diminished between 2020 and 2021 Although our results only provide a snapshot of the current mortality trends, they suggest widespread inequalities in COVID-19 mortality across older age groups in Latino communities.

Our results based on all-cause deaths indicate that the Latino mortality paradox persisted nationally in both 2020 and 2021 with whites having higher death rates than Latinos among persons 45 and older, despite narrowing Latino-white mortality gaps in the fall of 2020 (Sáenz & Garcia, 2021). However, there are important variations in the Latino mortality paradox across three sets of states that were examined. The Latino mortality paradox has persisted in 2020 and 2021 in Florida, Georgia, Illinois, North Carolina, Pennsylvania, and Washington and it was lost in 2020 but reemerged in 2021 in New Jersey, New York, and Texas. To a large degree, Latinos have higher vaccination rates than whites in these two sets of states where the Latino mortality paradox is currently present. In contrast, the Latino mortality paradox has largely been diminished in both 2020 and completely lost in 2021 in Arizona, California, Colorado, and New Mexico, states where the Latino vaccination rates significantly trail those of whites. Research shows that Latinos have exhibited a significant degree of resiliency during the pandemic including rising vaccination rates. However, the results of our analysis suggest that Latino resiliency, particularly in regard to mortality, may vary across states. Thus, it is crucial that we further examine levels of resiliency among Latinos to document trends in COVID-19 mortality rates both nationally and across states.

Drawing on previous research we discuss some of the factors underlining Latino-white disparities in COVID-19 mortality. Those with the greatest risk of exposure have been those working as frontline healthcare workers and essential employees. Occupational segregation has long led to Latinos working in more dangerous and deadly occupations compared to whites (Krieger, 2010). This pattern is evident during this pandemic as Latino workers are more likely to be employed in essential industries and occupations with frequent exposure to infections (Billock, Steege, & Miniño, 2022; Dyal et al., 2020; Goldman et al., 2021; Hawkins, 2020; Rho et al., 2020). Furthermore, these low-wage essential employees have little choice but to continue working as they have few resources to fall back on and are less likely to be able to work from home (Sáenz et al., 2021). These differences in occupation risk may be particularly important given the large mortality disparities observed for COVID-19 among those of working age compared to older adults. Indeed, the greater mortality among working-age people of color has contributed in part to Latinos exhibiting a reduction in life expectancy that is approximately three times as large as for whites (Andrasfay & Goldman, 2020; Woolf et al., 2021).

Latinos have higher COVID-19 mortality than whites at all ages (i.e., pre-and post-working years), indicating these disparities persist into older adulthood. One source of mortality for older adults is the high rate of infection in long-term care and nursing home settings. Long-term care facilities have high levels of racial stratification and lower quality of services for racial and ethnic minoritized groups (Mack et al., 2020; Rahman & Foster, 2015). Nursing homes and other long-term care settings that serve Latino older adults have a higher risk of COVID-19 outbreaks due to fewer financial resources to test and the inability to isolate infected residents within the facility (Shippee et al., 2020). Older Latinos may also have a greater risk of infection through household members, as multigenerational living arrangements are more common among Latinos (Vespa, Lewis, & Kreider, 2013).

Prior to the pandemic, unjust treatment of politically marginalized populations, racist policies, and discrimination have created a fundamentally unequal health landscape, with minimal effort to ameliorate these historical injustices (Berkowitz et al., 2020; Evans, 2020). To better understand Latino-white disparities in COVID-19 mortality, we must reckon with both the historical and contemporary inequalities that have led to the Latino-white differences in COVID-19 mortality we observe today (Berkowitz et al., 2020). For instance, the unethical treatment of Latinos in medical trials and forced sterilization clinics created a climate of mistrust between Latino communities and medical providers (Lombardo, 2011; Perez et al., 2022). In addition, redlining and other racist policies that have led to segregation have both direct and indirect pathways to COVID-19. Indirectly, these policies have constrained the wealth accumulation of Latino families resulting in massive wealth inequalities (Killewald et al., 2017).

An important contribution of our research is the examination of variation and magnitude in the Latino mortality paradox across 13 states with the largest Latino populations. Prior research has examined variation among U.S. Latinos in COVID-19 mortality nationally, by Census Regions, individual states, counties, and metro/non-metro areas (Do & Frank, 2021; Horner et al., 2022; Lundberg et al., 2022; Riley et al., 2021, 2022; Rodriguez-Diaz et al., 2020). This study builds on prior studies by documenting significant variation across states in the Latino mortality advantage over whites. We observe that Colorado and New Mexico and to a certain extent Arizona had relatively weak Latino mortality paradoxes prior to the pandemic. In contrast, two Latino new destination states—Georgia and North Carolina—characterized by a significant presence of immigrants have the most favorable mortality advantage over whites prior to and during the pandemic.

Additional research is needed to examine trends in state variations of the Latino mortality paradox. Researchers and policymakers should continue to monitor the impact of COVID-19 infection on Latino communities as recent evidence show that Latinos are more likely than whites to experience long COVID symptoms lasting 3 months or longer and report activity limitations from long COVID (Garcia, Garcia, & Bisesti, 2022). In addition, future research should examine whether high rates of COVID-19 infection will continue to diminish the Latino mortality advantage or whether the Latino population will continue to exhibit resiliency in longevity with the burden of disease (i.e., long COVID). This is of particular concern as Latinos report significantly lower levels of bivalent COVID-19 booster doses relative to whites (4% vs. 10%, respectively) (Ndugga, Hill, & Artiga, 2022) which may impact the risk of infection and the severity of the disease. Moreover, older Latinos have been shown to have low rates of healthcare coverage (García, Garcia, & Ailshire, 2022) which can influence their intention to be tested for COVID-19 infection or vaccinated (Perez et al., 2022). Attention to state variations may provide important contextual information to understand differences between Latinos and whites in the current stages of the pandemic and beyond. Finally, research has shown nativity status, country of origin, age of migration, and gender to be important axes of stratification in the United States that impact the health and mortality of the Latino population (Arias et al., 2020; Brown, 2018; Fenelon et al., 2017; Garcia, Garcia, & Ailshire, 2018; Garcia et al., 2018; Garcia, Reyes, et al., 2020; Garcia, Garcia, & Ailshire, 2022; Garcia, Tarraf, et al., 2022; Reyes & Garcia, 2020). Future studies should consider how the intersection of these identities differentially impacts COVID-19 mortality trends among the U.S. Latino population.

This analysis has some limitations. The data used are provisional and are subject to error in reporting of cause of death, race/ethnicity, and age. The cause of death may be especially biased given the lack of consistency and low levels of autopsies performed (Pappas, 2020). These mortality rates also only reflect part of the year (approximately 52 weeks in the year), and as the pandemic evolves may fluctuate. Finally, the data are subject to changes over time as racial/ethnic identification and causes of death are clarified along with the processing of recent, current, and future death certificates.

Our findings have implications for local, state, and federal policies aimed at addressing the myriad social and economic drivers of the excess mortality burden of COVID-19 on Latino communities. As a start, with COVID vaccination rolling out across the nation, our findings underscore categorizing Latinos —particularly from minority-dominant communities and neighborhoods—as a high-priority tier-one group for COVID-19 vaccinations. Second, expanding Medicaid as allowed under the ACA to states that have not adopted it has the potential to improve access to needed health resources for the optimal management of chronic conditions that elevate the risk for severe COVID and that are prevalent in communities of color. Our data underscore the need to strengthen and enforce workplace regulations that make work environments safer for frontline workers in the meatpacking industry, grocery stores, and other places at high risk of COVID-19 exposure.

Footnotes

Author Contributions: MG and RS planned the study and contributed to the development and drafting/editing of the manuscript and interpretation of the results.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Marc A. Garcia https://orcid.org/0000-0002-9442-4124

References

  1. Aburto J. M., Tilstra A. M., Floridi G., Dowd J. B. (2022). Significant impacts of the COVID-19 pandemic on race/ethnic differences in USA mortality. medRxiv. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Andrasfay T., Goldman N. (2020). Impact of COVID-19 on 2020 US life expectancy for the Black and Latino populations. medRxiv. 10.1101/2020.07.12.20148387 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. APM Research Lab (2022). The color of coronavirus: COVID‐19 deaths by race and ethnicity U.S https://www.apmresearchlab.org/covid/deaths-by-race [Google Scholar]
  4. Arias E., Johnson N. J., Vera B. T. (2020). Racial disparities in mortality in the adult hispanic population. SSM - Population Health, 11, 100583. 10.1016/j.ssmph.2020.100583 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Arias E., Tejada-Vera, Betzaida K., Kenneth D., Ahmad F. B. (2022). Provisional life expectancy estimates for 2021. Suicide Prevention Resource Center. [Google Scholar]
  6. Aschmann H. E., Riley A. R., Chen R., Chen Y.-H., Bibbins-Domingo K., Stokes A. C., Glymour M. M., Kiang M. V., Mathew V. (2022). Dynamics of racial disparities in all-cause mortality during the COVID-19 pandemic. Proceedings of the National Academy of Sciences of the United States of America, 119(40), e2210941119. 10.1073/pnas.2210941119 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Berkowitz S. A., Cené C. W., Chatterjee A. (2020). Covid-19 and health Equity—time to Think Big. The New England Journal of Medicine, 383(12), e76. 10.1056/NEJMp2021209 [DOI] [PubMed] [Google Scholar]
  8. Billock, Rachael M., Steege A. L., Miniño A. (2022). COVID-19 mortality by usual occupation and industry: 46 states and New York City, United States, 2020. Natl Vital Stat Rep, 71(6), 1–33. [PubMed] [Google Scholar]
  9. Brown T. H. (2018). Racial stratification, Immigration, and health inequality: A life course-Intersectional Approach. Social Forces, 96(4), 1507–1540. 10.1093/sf/soy013 [DOI] [Google Scholar]
  10. Cantu P. A., Hayward M. D., Hummer R. A., Chiu C.-T. (2013). New estimates of racial/ethnic differences in life expectancy with chronic morbidity and functional loss: Evidence from the National Health Interview Survey. Journal of Cross-Cultural Gerontology, 28(3), 283–297. 10.1007/s10823-013-9206-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. CDC (2022. a). COVID data Tracker. Retrieved Nov. 27, 2022, fromhttps://covid.cdc.gov/covid-data-tracker/#demographics [Google Scholar]
  12. CDC . (2022. b). Provisional death counts for coronavirus disease 2019 (COVID-19). Retrieved April 10, 2022, fromhttps://www.cdc.gov/nchs/nvss/covid-19.htm [Google Scholar]
  13. Davis O., Fisher B., Ghilarducci T., Radpour S. (2020). A first in nearly 50 years, older workers face higher unemployment than mid-career workers. Status of older workers report Series. SCEPA Publication Series. [Google Scholar]
  14. Do D. P., Frank R. (2021). Using race-and age-specific COVID-19 case data to investigate the determinants of the excess COVID-19 mortality burden among Hispanic Americans. Demographic Research, 44, 699–718. 10.4054/demres.2021.44.29 [DOI] [Google Scholar]
  15. Dyal J. W., Grant M. P., Broadwater K., Bjork A., Waltenburg M. A., Gibbins J. D. (2020). COVID-19 among workers in Meat and Poultry processing facilities―19 states, April 2020. MMWR. Morbidity and Mortality Weekly Report, 69(18), 557–561. 10.15585/mmwr.mm6918e3 [DOI] [PubMed] [Google Scholar]
  16. Evans M. K. (2020). Covid’s color line—Infectious disease, inequity, and racial justice. The New England Journal of Medicine, 383(5), 408–410. doi: DOI: 10.1056/NEJMp2019445 [DOI] [PubMed] [Google Scholar]
  17. Fenelon A., Chinn J. J., Anderson R. N. (2017). A comprehensive analysis of the mortality experience of hispanic subgroups in the United States: Variation by age, country of origin, and nativity. SSM - Population Health, 3, 245–254. 10.1016/j.ssmph.2017.01.011 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Garcia C., Garcia M. A., Ailshire J. A. (2018. a). Sociocultural Variability in the Latino population: Age patterns and differences in morbidity among older US adults. Demographic Research, 38(52), 1605–1618. 10.4054/DemRes.2018.38.52 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Garcia C., Garcia M. A., Ailshire J. A. (2022). Demographic and health characteristics of older Latino birth cohorts in the Health and Retirement Study. The Journals of Gerontology: Series B 77.11, 2060–2071. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Garcia M. A., Downer B., Chiu C. T., Sáenz J. L., Ortiz K., Wong R., Ortiz K., Wong R. (2021). Educational Benefits and Cognitive health life Expectancies: Racial/ethnic, nativity, and gender disparities. The Gerontologist, 61(3), 330–340. 10.1093/geront/gnaa112 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Garcia M. A., Downer B., Chiu C. T., Sáenz J. L., Rote S., Wong R., Wong R. (2019). Racial/ethnic and nativity differences in Cognitive life Expectancies among older adults in the United States. The Gerontologist, 59(2), 281–289. 10.1093/geront/gnx142 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Garcia M. A., Garcia C., Bisesti E. (2022). The unequal burden of long COVID. Syracuse University. [Google Scholar]
  23. Garcia M. A., Garcia C., Chiu C.-T., Raji M., Markides K. S. (2018). A comprehensive analysis of morbidity life Expectancies among older hispanic subgroups in the United States: Variation by nativity and country of origin. Innovation in Aging, 2(2), igy014. 10.1093/geroni/igy014 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Garcia M. A., Homan P. A., García C., Brown T. H. (2021). The color of COVID-19: Structural racism and the disproportionate impact of the pandemic on older black and Latinx adults. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 76(3), e75–e80. 10.1093/geronb/gbaa114 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Garcia M. A., Reyes A. M., García C., Chiu C. T., Macias G., Chi-Tsun, Macias G. (2020). Nativity and country of origin variations in life expectancy with functional limitations among older Hispanics in the United States. Research on Aging, 42(7–8), 199–207. 10.1177/0164027520914512 [DOI] [PubMed] [Google Scholar]
  26. Garcia M. A., Tarraf W., Reyes A. M., Chiu C.-T. (2022). Gender, age of migration, and Cognitive life Expectancies among older Latinos: Evidence from the health and Retirement study. The Journals of Gerontology: Series B, 77(12), e226–e233. 10.1093/geronb/gbac133 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Garcia M. A., Thierry A. D., Pendergrast C. B. (2022). The devastating economic impact of Covid-19 on older black and Latinx adults: Implications for health and well-being. The Journals of Gerontology: Series B, 77(8), 1501–1507. 10.1093/geronb/gbab218 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Goldman N., Pebley A. R., Lee K., Andrasfay T., Pratt B. (2021). Racial and ethnic differentials in COVID-19-related job exposures by occupational standing in the US. PloS One, 16(9), e0256085. 10.1371/journal.pone.0256085 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Hawkins D. (2020). Differential occupational risk for COVID‐19 and other infection exposure according to race and ethnicity. American Journal of Industrial Medicine, 63(9), 817–820. 10.1002/ajim.23145 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Hayward M. D., Hummer R. A., Chiu C.-T., González-González C., Wong R. (2014). Does the hispanic paradox in U.S. Adult mortality Extend to disability? Population Research and Policy Review, 33(1), 81–96. 10.1007/s11113-013-9312-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Horner K. M., Wrigley-Field E., Leider J. P. (2022). A first Look: Disparities in COVID-19 mortality among US-born and foreign-born Minnesota residents. Population Research and Policy Review, 41(2), 465–478. 10.1007/s11113-021-09668-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Hummer R. A., Hernandez E. M. (2013). The effect of educational attainment on adult mortality in the United States. Population Bulletin, 68(1), 1–16 [PMC free article] [PubMed] [Google Scholar]
  33. Killewald A., Pfeffer F. T., Schachner J. N. (2017). Wealth inequality and accumulation. Annual Review of Sociology, 43, 379–404. 10.1146/annurev-soc-060116-053331 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Klein A., Smith E. (2021). Explaining the economic impact of COVID-19: Core industries and the Hispanic workforce. Brookings Institution. [Google Scholar]
  35. Krieger N. (2010). Workers are people too: Societal aspects of occupational health disparities—An ecosocial perspective. American Journal of Industrial Medicine, 53(2), 104–115. 10.1002/ajim.20759 [DOI] [PubMed] [Google Scholar]
  36. Lariscy J. T., Hummer R. A., Hayward M. D. (2015). Hispanic older adult mortality in the United States: New estimates and an assessment of factors Shaping the hispanic paradox. Demography, 52(1), 1–14. 10.1007/s13524-014-0357-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Lombardo P. A. (2011). A century of eugenics in America: From the Indiana experiment to the human genome era. Indiana University Press. [Google Scholar]
  38. Luck A. N., Preston S. H., Elo I. T., Stokes A. C. (2022). The unequal burden of the Covid-19 pandemic: Capturing racial/ethnic disparities in US cause-specific mortality. SSM - Population Health, 17, 101012. 10.1016/j.ssmph.2021.101012 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Lundberg D. J., Cho A., Raquib R., Nsoesie E. O., Wrigley-Field E., Stokes A. C. (2022). Geographic and Temporal patterns in Covid-19 mortality by race and ethnicity in the United States from March 2020 to February 2022. medRxiv. [Google Scholar]
  40. Mack D. S., Jesdale B. M., Ulbricht C. M., Forrester S. N., Michener P. S., Lapane K. L., Lapane K. L. (2020). Racial segregation across US nursing homes: A systematic review of measurement and outcomes. The Gerontologist, 60(3), e218–e231. 10.1093/geront/gnz056 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Mackey K., Ayers C. K., Kondo K. K., Saha S., Advani S. M., Young S., Spencer H., Anderson J., Veazie S., Smith M., Kansagara D., Rusek M., Stephanie (2021). Racial and ethnic disparities in COVID-19–related infections, hospitalizations, and deaths: A systematic review. Annals of Internal Medicine, 174(3), 362–373. 10.7326/M20-6306 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Markides K. S., Eschbach K. (2005). Aging, migration, and mortality: Current status of research on the Hispanic paradox. Journals of Gerontology Series B-Psychological Sciences and Social Sciences, 60 Spec(2), 68–75. 10.1093/geronb/60.special_issue_2.s68 [DOI] [PubMed] [Google Scholar]
  43. Markides K. S., Eschbach K. (2011). Hispanic paradox in adult mortality in the United States International handbook of adult mortality (pp. 227–240). Springer. [Google Scholar]
  44. Marlow E. C., Jemal A., Thomson B., Wiese D., Zhao J., Siegel R. L., Islami F. (2022). Mortality by education before and during the COVID-19 pandemic, US, 2017–2020. American Journal of Preventive Medicine, 64(1), 105–116. 10.1016/j.amepre.2022.08.015 [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Montez J. K., Beckfield J., Cooney J. K., Grumbach J. M., Hayward M. D., Koytak H. Z., Woolf S. H., Zajacova A., Zeyd H., Zajacova A. (2020). US state policies, politics, and life expectancy. The Milbank Quarterly, 98(3), 668–699. 10.1111/1468-0009.12469 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Montez J. K., Farina M. P. (2021). Do liberal US state policies maximize life expectancy? Public Policy & Aging Report, 31(1), 7–13. 10.1093/ppar/praa035 [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Montez J. K., Zajacova A., Hayward M. D., Woolf S. H., Chapman D., Beckfield J. (2019). Educational disparities in adult mortality across US states: How do they differ, and have they changed since the mid-1980s? Demography, 56(2), 621–644. 10.1007/s13524-018-0750-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Montez J. K., Mehri N., Monnat S. M., Beckfield J., Chapman D., Grumbach J. M., Hayward M. D., Woolf S. H., Zajacova A., Zajacova A. (2022). US state policy contexts and mortality of working-age adults. PLoS One, 17(10), e0275466. 10.1371/journal.pone.0275466 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Ndugga N., Hill L., Artiga S. (2022. a). COVID-19 cases and deaths, vaccinations, and treatments by race/ethnicity as of fall 2022. Kaiser Family Foundation. [Google Scholar]
  50. Ndugga N., Pham O., Hill L., Artiga S., Alam R., Parker N. (2022. b). Latest data on COVID-19 vaccinations race/ethnicity. Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/ [Google Scholar]
  51. Pappas S. (2020). How COVID-19 deaths are counted. Scientific American. [Google Scholar]
  52. Perez A., Johnson J. K., Marquez D. X., Keiser S., Martinez P., Guerrero J., Tran T., Portacolone E. (2022). Factors related to COVID-19 vaccine intention in Latino communities. Plos One, 17(11), e0272627. 10.1371/journal.pone.0272627 [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Rahman M., Foster A. D. (2015). Racial segregation and quality of care disparity in US nursing homes. Journal of Health Economics, 39, 1–16. 10.1016/j.jhealeco.2014.09.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Reyes A. M., Garcia M. A. (2020). Gender and age of migration differences in mortality among older Mexican Americans. The Journals of Gerontology: Series B, 75(8), 1707–1718. 10.1093/geronb/gbz038 [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Rho H. J., Brown H., Fremstad S. (2020). A basic demographic profile of workers in frontline industries. Center for Economic and Policy Research, p. 7. [Google Scholar]
  56. Riley A. R., Chen Y.-H., Matthay E. C., Glymour M. M., Torres J. M., Fernandez A., Bibbins-Domingo K., Kirsten (2021). Excess mortality among Latino people in California during the COVID-19 pandemic. SSM - Population Health, 15, 100860. 10.1016/j.ssmph.2021.100860 [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Riley A. R., Kiang M. V., Chen Y-H., Bibbins-Domingo K., Glymour M. M. (2022). Recent shifts in racial/ethnic disparities in COVID-19 mortality in the vaccination period in California. Journal of General Internal Medicine, 37(7), 1818–1820. 10.1007/s11606-021-07380-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Rodriguez-Diaz C. E., Guilamo-Ramos V., Mena L., Hall E., Honermann B., Crowley J. S., Baral S., Prado G. J., Marzan-Rodriguez M., Beyrer C., Sullivan P. S., Millett G. A., Millett Gregorio A. (2020). Risk for COVID-19 infection and death among Latinos in the United States: Examining heterogeneity in transmission dynamics. Annals of Epidemiology, 52, 46–53.e2. 10.1016/j.annepidem.2020.07.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Sáenz R., Garcia M. A. (2021). The disproportionate impact of COVID-19 on older Latino mortality: The rapidly diminishing Latino paradox. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 76(3), e81–e87. 10.1093/geronb/gbaa158 [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Sáenz R., Garcia Marc A. (2022). White COVID-19 deaths increased more in red states than in Blue states in 2021. Lerner Center for Public Health Promotion: Population Health Research Brief Series 178. https://surface.syr.edu/lerner/178 [Google Scholar]
  61. Sáenz R., Garcia M. A., Pendergrast C. (2022). COVID-19 deaths Soared among US whites in 2021. Syracuse University. [Google Scholar]
  62. Sáenz R., Sparks C., Validova A. (2021). Inequities in job Recovery during the COVID-19 pandemic: A Year later. University of New Hampshire. [Google Scholar]
  63. Shippee T. P., Akosionu O., Ng W., Woodhouse M., Duan Y., Thao M.S., Bowblis J. R. (2020). COVID-19 pandemic: Exacerbating racial/ethnic disparities in long-term services and supports. Journal of Aging & Social Policy, 32(4-5), 323–333. 10.1080/08959420.2020.1772004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Truman B. I., Chang M.-H., Moonesinghe R. (2022). Provisional COVID-19 age-adjusted death rates, by race and ethnicity—United States, 2020–2021. MMWR. Morbidity and Mortality Weekly Report, 71(17), 601–605. 10.15585/mmwr.mm7117e2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Turra C. M., Goldman N. (2007). Socioeconomic differences in mortality among U.S. Adults: Insights into the hispanic paradox. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 62(3), S184–S192. 10.1093/geronb/62.3.S184 [DOI] [PubMed] [Google Scholar]
  66. US Census Bureau. (2021). US census Bureau QuickFacts: United States. [Google Scholar]
  67. Vespa J., Lewis J. M., Kreider R. M. (2013). America’s families and living arrangements: 2012. Current Population Reports, 20(2013), P570. [Google Scholar]
  68. Wiltz J. L., Feehan A. K., Molinari N. M., Ladva C. N., Truman B. I., Hall J., Block J. P., Rasmussen S. A., Denson J. L., Trick W. E., Weiner M. G., Koumans E., Gundlapalli A., Carton T. W., Boehmer T. K. (2022). Racial and ethnic disparities in Receipt of Medications for treatment of COVID-19—United States, March 2020–August 2021. MMWR. Morbidity and Mortality Weekly Report, 71(3), 96–102. 10.15585/mmwr.mm7103e1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Woolf S. H., Masters R. K., Aron L. Y. (2021). Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: Simulations of provisional mortality data. BMJ, 373, n1343. 10.1136/bmj.n1343 [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. Yek C., Warner S., Wiltz J. L., Sun J., Adjei S., Mancera A., Boehmer T. K. (2022). Risk factors for severe COVID-19 outcomes among persons Aged≥ 18 Years who completed a Primary COVID-19 vaccination Series—465 health care facilities, United States, December 2020–October 2021. Morbidity and Mortality Weekly Report, 71(1), 19. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Aging and Health are provided here courtesy of SAGE Publications

RESOURCES