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Published in final edited form as: Public Health. 2024 May 3;231:173–178. doi: 10.1016/j.puhe.2024.03.016

Increased COVID-19 Mortality Among Immigrants Compared to U.S.-Born Individuals: A Cross Sectional Analysis of 2020 Mortality Data

Adrian M Bacong 1,2, Richie Chu 2,3,4, Austin Le 5, Vivian Bui 6, Ewen Wang 2,7, Latha Palaniappan 1,2
PMCID: PMC11488693  NIHMSID: NIHMS1982440  PMID: 38703491

Abstract

Objective:

Multiple studies have shown that racially minoritized groups had disproportionate COVID-19 mortality relative to Non-Hispanic White individuals. However, there is little known regarding mortality by immigrant status nationally in the United States, despite being another vulnerable population.

Study Design:

Observational cross-sectional study using mortality vital statistics system data to calculate proportionate mortality ratios (PMR) and mortality rates due to COVID-19 as the underlying cause.

Methods:

Rates were compared by decedents’ identified race, ethnicity (Hispanic vs. Non-Hispanic), and immigrant (immigrants vs. U.S.-born) status. Asian race was further disaggregated into “Asian Indian”, “Chinese”, “Filipino”, “Japanese”, “Korean”, and “Vietnamese”.

Results:

Of the over 3.4 million people who died in 2020, 10.4% of all deaths were attributed to COVID-19 as the underlying cause (n=351,530). Over double (18.9%, n=81,815) the percentage of immigrants died of COVID-19 compared to U.S.-born decedents (9.1% n=269,715). PMR due to COVID-19 were higher among immigrants as compared to U.S.-born individuals for Non-Hispanic White, Non-Hispanic Black, Hispanic and most disaggregated Asian groups. Among disaggregated Asian immigrants, age-and sex-adjusted PMR due to COVID-19 ranged from 1.58 times greater mortality among Filipino immigrants (95% CI: 1.53, 1.64) to 0.77 times greater mortality among Japanese immigrants (95% CI: 0.68, 0.86). Age-adjusted mortality rates were also higher among immigrant individuals compared to U.S.-born people.

Conclusions:

Immigrant individuals experienced greater mortality due to COVID-19 compared to their U.S.-born counterparts. As COVID-19 becomes more endemic, greater clinical and public health efforts are needed to reduce disparities in mortality among immigrants compared to their U.S.-born counterparts.

Keywords: COVID-19, Mortality, Asian American, Hispanic, Health Disparities

Introduction

The COVID-19 pandemic has had disparate impacts on racially minoritized groups, especially American Indian/Alaska Native, Black, Hispanic, and Native Hawaiians/Pacific Islander peoples. Compared to Non-Hispanic White people, these groups experienced increased COVID-19 infection, complication, and excess mortality1–5 resulting in decreased life expectancy.6 In 2022, 186,702 people died of COVID-19 in the United States (U.S.), making it the fourth leading cause of death.7 As of August 2023, approximately 1.1 million people have died of COVID-19 in the U.S.8

The initial narrative surrounding the experiences of Asian American individuals during the COVID-19 pandemic emphasized a lower infection and mortality among this group as an aggregate.1,3 However, Asian Americans, the fastest growing race/ethnicity group in the US, are also an incredibly heterogeneous group. Thus, the initial findings of a health advantage among Asian American groups may have arisen from issues of data aggregation.9 Indeed, community reports indicated that both aggregated and disaggregated Asian American groups experienced greater COVID-19 burden relative to other race and ethnic groups.10–12 For example, Asian American people in San Francisco experienced a greater case-fatality rate relative to other race and ethnic groups.10 South Asian people in New York experienced the highest infection (30.8%) and hospitalization (51.6%) rates among Asian patients, only second to Hispanic (32.1% and 45.8% respectively) and Black individuals (27.5% and 57.5%, respectively).12 Non-Hispanic White individuals, in comparison, faced greater COVID-19 burdens with higher hospitalization rates despite lower infection rates. Additional studies of healthcare systems have corroborated these findings, noting increased COVID-19 infection rates among Asian Indian and Filipino people.13 Filipino people have had higher COVID-19 burden and mortality nationally.11 Recently, one study noted that the four major Asian American groups (i.e., Asian Indian, Chinese, Filipino, and Vietnamese) experienced greater mortality during the initial year of the COVID-19 pandemic relative to Non-Hispanic White individuals,14 with the largest decreases in life expectancy seen among Filipino individuals. Although COVID-19 mortality rates have decreased for Asian individuals since the beginning of the COVID-19 pandemic,15 the general pre-pandemic all-cause mortality advantage that Asian Americans had compared to Non-Hispanic White individuals decreased.16

What has not been well examined, is how COVID-19 mortality differs by immigration status (i.e., immigrant versus U.S.-born). Immigration status is an important social stratifying factor to consider, given that there may be structural barriers that prevented immigrants from receiving adequate care for COVID-19. For example, initial political rhetoric discouraged immigrants’ (especially undocumented immigrants) use of COVID-19 prevention services with fears that they would be labeled as a “public charge”17–19 or face potential deportation.20 Furthermore, social services, such as paid leave, were utilized at lower rates among immigrants compared to U.S.-born individuals.21 Immigrants may also have increased exposure to the SARS-CoV2 virus due to working in “essential” industries such as agricultural, service, or healthcare industries.18,19,22 Finally, immigrant individuals often live in multigenerational households where they may experience potential overcrowding which could increase the likelihood of infection.18

Thus, it is possible that immigrants may have also experienced disproportionate infection and mortality due to COVID-19. Indeed, undocumented immigrants in Los Angeles County had greater odds of visiting emergency rooms for COVID-19 than those with Medicaid.23 Additionally, Hispanic immigrants in California24 and Minnesota25 experienced greater mortality due to COVID-19 relative to their U.S.-born counterparts. While these county- and state-level studies are informative, no national study of COVID-19 mortality among immigrants has been conducted. In this study, we examine disparities in COVID-19 mortality by immigration status during the initial year of the COVID-19 pandemic (2020) and whether disparities in mortality differed among Hispanic and disaggregated Asian groups, the two largest immigrant populations in the U.S. In addition, we also compare these trends to Non-Hispanic Black and Non-Hispanic White individuals, the two largest race groups in the U.S.

Methods

We used data from the 2020 National Vital Statistics System (NVSS),26 which contain mortality and demographic information on 3,390,278 decedents. We restrict our analysis to 2020 data, as these are the only publicly available data at the time of the study. As publicly available data, this study was exempt by the Stanford University Institutional Review Board.

Mortality due to COVID-19 as the underlying cause of death was determined using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) code U07.1 (COVID-19, virus identified).27

Immigrant status and race/ethnicity were our two independent variables of interest. Immigrant status was dichotomized as “U.S.-born” (place of birth in any U.S. state or District of Columbia) and “Immigrant” (place of birth elsewhere).

Decedents’ race and ethnicity information were provided by a spouse, parent, child, other relative, or another knowledgeable person familiar with the decedent. In cases where a preferred informant is not available or unable to provide the necessary information, the responsibility of determining the decedent’s race and ethnicity fell upon the coroner or physician.28 Race and ethnicity were classified into the following: Non-Hispanic African American/Black, Non-Hispanic American Indian or Alaska Native, Non-Hispanic Asian American, Hispanic, Non-Hispanic Native Hawaiian and Pacific Islander (Guamanian and Samoan), Non-Hispanic White, and Other Race or Ethnicity, and Other Asian/and or Pacific Islander. Asian groups were further disaggregated into the six available groups in NVSS: Asian Indian, Chinese, Filipino, Korean, Japanese, and Vietnamese. We were unable to examine other disaggregated Asian groups (e.g., Cambodian, Hmong, Thai) as they were not available in public-use mortality data. Covariates included age category (<18 years, 18–25 years, 26–39 years, 40–64 years, 65+ years) and sex (female or male).

Statistical Analysis

We first compared the distributions of decedents’ demographic factors by immigrant status. We then calculated proportional mortality due to COVID-19 as the underlying cause by immigrant status. Next, we calculated indirectly standardized proportionate mortality ratios (PMR) with 95% confidence intervals (CI) by race and immigrant status, adjusted for age and sex.29,30.

Finally, we calculated both crude and COVID-19 age-adjusted standardized mortality rates by race, ethnicity, and immigrant status. We used the 2020 American Community Survey (ACS)31 as the denominator data when calculating age-adjusted mortality rates. Age-adjusted mortality rates were calculated using direct standardization with the “epitools” package in R32 and the age distribution of the American Community Survey 2020 as the standard population. All analyses were conducted in R Studio version 2023.06.1+524.33

Results

Of the 3.4 million people who died in 2020 (Table 1), 10.4% of all deaths were attributed to COVID-19 as the underlying cause (n=351,530). There were distinct differences in mortality by immigration status in 2020 (Table 1). Although the majority of decedents were U.S.-born, only 9.1% of U.S.-born individuals died of COVID-19 (n=269,715). In comparison, the proportional mortality among immigrant individuals was over twice that of U.S.-born individuals (18.9% or n=81,815).

Table 1.

Decedent Characteristics by Immigrant Status, 2020 National Vital Statistics System Mortality Data

Variable Total Immigrants U.S.-Born
N (%) N (%) N (%)
Number of Decedents 3,390,278 433,408 2,956,870
Variable
COVID-19 Decedents 		351,530 (10.4%) 81,815 (18.9%) 269,715 (9.1%)
Age Group, in Years*
< 18		 34,148 (1.0%) 725 (0.2%) 33,423 (1.1%)
18–25 36,382 (1.1%) 3,032 (0.7%) 33,350 (1.1%)
26–39 116,457 (3.4%) 12,081 (2.8%) 104,376 (3.5%)
40–64 690,678 (20.4%) 97,739 (22.6%) 592,939 (20.1%)
65+ 2,512,319 (74.1%) 319,617 (73.7%) 2,192,702 (74.2%)
Female Sex 1,615,706 (47.7%) 198,437 (45.8%) 1,417,269 (47.9%)
Race and Ethnicity
African American or Black		 452,650 (13.4%) 37,767 (8.71%) 414,883 (14.0%)
American Indian or Alaska Native 26,777 (0.8%) 400 (0.1%) 26,377 (0.9%)
Asian American 78,618 (2.3%) 67,141 (15.5%) 11,477 (0.4%)
Hispanic 307,612 (9.0%) 159,017 (36.7%) 148,595 (5.0%)
Native Hawaiian 919 (0.0%) 16 (0.0%) 903 (0.0%)
Pacific Islander (Guam + Samoan) 1,654 (0.0%) 454 (0.1% 1200 (0.04%)
Other Race or Ethnicity** 8,890 (0.3%) 5,235 (1.2%) 3,655 (0.1%)
Other Asian and/or Pacific Islander 19,357 (0.6%) 14,630 (3.4%) 4,727 (0.2%)
White 2,493,801 (73.6%) 148,748 (34.3%) 2,345,053 (79.3%)
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*

Missing n=294

**

Includes decedents with missing Hispanic ethnicity information.

There are similar trends when examining COVID-19 mortality among Hispanic and disaggregated Asian ethnic groups (Table 2). For Hispanic individuals, nearly double the immigrants died of COVID-19 (27.7%) when compared to U.S.-born individuals (14.5%). The six major Asian groups had similar trends; immigrants had greater proportional mortality due to COVID-19 than U.S.-born individuals. Proportional mortality was greatest among Filipino immigrants (17.0%), followed by Asian Indian immigrants (14.6%) and Vietnamese immigrants (14.5%). Proportional mortality was lowest among U.S.-born Korean individuals (3.8%). Proportional mortality was higher among immigrants as compared to U.S.-born individuals for all Asian and Hispanic groups examined.

Table 2.

COVID-19 Proportional Mortality, Proportionate Mortality Ratio, and Age-Adjusted Mortality Rate by Race and Immigrant Status

Total Decedents (N = 3,390,278) Number of COVID-19 Decedents (N =351,530) Proportional Mortality (%) Proportionate Mortality Ratio Crude Rate (per 100,000) Age-Adjusted Rate (per 100,000)
Ethnic Category Immigrant U.S.-Born Immigrant U.S.-Born Immigrant U.S.-Born Immigrant U.S.-Born Immigrant U.S.-Born Immigrant U.S.-Born
All Decedents 433,408 2,956,870 81,815 269,715 18.9% 9.1% 1.79 (1.78, 1.81) 0.88 (0.88, 0.88) 188.1 (187.8, 188.5) 94.3 (94.2, 94.4) 170.0 (168.9, 171.1) 85.9 (85.5, 86.2)
Asian Indian 11,999 661 1,752 35 14.6% 5.3% 1.37 (1.30, 1.43) 1.29 (0.89, 1.79) 62.4 (62.1, 63.0) 2.9 (2.8, 2.9) 72.3 (71.6, 73.0) 23.4 (22.4, 24.4)
Chinese 18,523 2,154 2,388 192 12.9% 8.9% 1.19 (1.14, 1.23) 0.90 (0.78, 1.04) 84.9 (84.6, 85.3) 13.9 (13.8, 14.0) 65.0 (64.5, 65.4) 31.9 (31.3, 32.6)
Filipino 16,290 1,749 2,762 145 17.0% 8.3% 1.58 (1.53, 1.64) 0.94 (0.79, 1.11) 152.9 (152.0, 153.7) 15.3 (15.2, 15.4) 96.1 (95.3, 97.0) 34.0 (33.1, 34.9)
Japanese 3,279 6,241 265 342 8.1% 5.5% 0.77 (0.68, 0.86) 0.49 (0.45, 0.55) 85.0 (84.0,86.1) 80.2 (79.2, 81.2) 58.7 (57.5, 60.0) 39.4 (38.7, 40.2)
Korean 8,016 340 1,145 13 14.3% 3.8% 1.33 (1.26, 1.41) 0.53 (0.28, 0.91) 115.6 (114.8, 116.4) 2.9 (2.9, 3.0) 83.3 (82.3, 84.4) 17.2 (16.3, 18.3)
Vietnamese 9,034 332 1,310 21 14.5% 6.3% 1.35 (1.28, 1.43) 1.85 (1.14, 2.83) 102.4 (101.7, 103.0) 3.3 (3.3, 3.4) 72.0 (71.2, 72.7) 13.6 (13.1, 14.1)
Hispanic 159,017 148,595 44,014 21,584 27.7% 14.5% 2.69 (2.67, 2.72) 1.59 (1.57, 1.61) 227.9 (227.3, 228.4) 51.6 (51.5, 51.7) 243.6 (241.6, 245.5) 100.3 (99.5, 101.1)
Non-Hispanic Black 37,767 414,883 7,693 48,907 20.4% 11.8% 1.98 (1.94, 2.03) 1.22 (1.21, 1.23) 203.9 (203.0, 204.7) 138.9 (138.6, 139.2) 199.3 (197.5, 201.0) 153.5 (152.9, 154.1)
Non-Hispanic White 148,748 2,345,053 16,660 193,119 11.2% 8.2% 1.04 (1.02, 1.06) 0.78 (0.78, 0.78) 230.6 (229.9, 231.2) 103.8 (103.6, 103.9) 136.4 (135.8, 137.0) 77.8 (77.6, 77.9)
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Note. Proportionate Mortality Ratio is adjusted for age and sex using indirect standardization. Age-Adjusted rates are directly standardized using the age-distribution of the 2020 American Community Survey.

Trends were similar for Non-Hispanic Black and Non-Hispanic White individuals. A larger proportion of Non-Hispanic Black immigrants (20.4%) died of COVID-19 when compared to U.S.-born Non-Hispanic Black people (11.8%). Among Non-Hispanic White people, a larger proportion of immigrants died of COVID-19 (11.2%) than U.S.-born individuals (1.4%).

The age-and sex-adjusted proportionate mortality ratio (PMR) comparing observed number of deaths due to COVID-19 versus expected number of deaths due to COVID-19 was 1.79 (95% CI = 1.78, 1.81) for immigrants and 0.88 (95% CI = 0.88, 0.88) for U.S.-born individuals, regardless of race (Table 2). In general, PMR was higher among immigrants as compared to U.S.-born for all race and ethnic groups, except Vietnamese immigrants. PMR among immigrants was highest among Hispanic individuals (2.69, 95% CI = 2.67, 2.72), followed by Non-Hispanic Black individuals (1.98, 95% CI = 1.94, 2.03). There was large heterogeneity in PMR among disaggregated Asian immigrants. Filipino immigrants had the highest PMR (1.58, 95% CI = 1.53, 1.64), followed by Asian Indian immigrants (1.37, 95% CI = 1.30, 1.43) while Japanese immigrants had the lowest PMR (0.77, 95% CI = 0.68, 0.86). All disaggregated Asian groups had higher PMR compared to Non-Hispanic White immigrants (1.04, 95% CI = 1.02, 1.06) except for Japanese immigrants.

Among U.S.-born individuals, Vietnamese individuals had the highest PMR (1.85, 95% CI = 1.14, 2.83) while Japanese individuals had the lowest PMR (0.49, 95% CI = 0.45, 0.55). In comparison, U.S.-born Hispanic individuals had the second highest PMR (1.59, 95% CI = 1.57, 1.61), followed by U.S.-born Asian Indian individuals (1.29, 95% CI = 0.89, 1.79).

The age--adjusted mortality rate for COVID-19 per 100,000 among immigrants (Table 2) was higher (170.0, 95% CI = 168.9, 171.1) than U.S.-born individuals (85.9, 95% CI = 85.5, 86.2). There was also large heterogeneity in COVID-19 age-adjusted mortality rate per 100,000 by race and immigrant status. Among immigrants, age-adjusted mortality rates were highest among Hispanic individuals (243.6, 95% CI = 241.6, 245.5), followed by Filipino (96.1, 95% CI = 95.3, 97.0), and Korean individuals (83.3, 95% CI = 82.3, 84.4). Among immigrants, Japanese individuals had the lowest age-adjusted mortality rate (58.7, 95% CI = 57.5, 60.0). In comparison, all U.S.-born groups had lower age-adjusted mortality rates when compared to their immigrant counterparts. U.S.-born Hispanic individuals had the highest age-adjusted mortality rates (100.3, 95% CI = 99.5, 101.1) while Vietnamese individuals had the lowest age-adjusted mortality rates (13.6, 95% CI = 13.1, 14.1). In contrast, age-adjusted mortality rates among Non-Hispanic Black and Non-Hispanic White people were higher in comparison to all Asian groups. Specifically, the age-adjusted mortality rates for Non-Hispanic Black and Non-Hispanic White immigrants was 199.3 per 100,000 (95% CI = 197.5, 201.0) and 136.4 per 100,000 (95% CI = 135.8, 137.0), respectively. For U.S.-born Non-Hispanic Black and Non-Hispanic White individuals, age-adjusted mortality rates were 153.5 per 100,000 (95% CI = 152.9, 154.1) and 77.8 per 100,000 (95% CI = 77.6, 77.9), respectively. Thus, although immigrant Non-Hispanic Black and Non-Hispanic White people had greater mortality compared to their U.S.-born counterparts, their overall mortality rates were higher relative to and Asian groups.

Discussion

The COVID-19 pandemic has led to disparate impacts in mortality among racially minoritized groups. However, the burden of COVID-19 among immigrant groups has not been well studied explored nationally, despite state-level reports of greater COVID-19 burden among immigrants.24,25 Our study utilizes national mortality data to compare mortality due to COVID-19 by both race and immigrant status. We find that among the general population, over double the proportion of immigrants died of COVID-19 than U.S.-born individuals. In addition, there was vast heterogeneity in the proportionate mortality ratios for immigrants who died of COVID-19 compared to U.S.-born individuals who died of COVID-19. Among immigrants, Hispanic individuals experienced the greatest burden, where nearly 2.7 times the number of immigrants died of COVID-19 than expected. Among U.S.-born individuals, Vietnamese people experienced the greatest burden where nearly 1.9 times the number of U.S.-born Vietnamese people died of COVID-19 than was expected.. However, it should be noted that the number of deaths among U.S.-born Korean and Vietnamese individuals was very low. This may be due to the high percentage of Vietnamese and Korean immigrants; 62% of Vietnamese people and 60% of all Koreans in the U.S. are immigrants.34–36 When examining Asian immigrants specifically, Filipino immigrants had the greatest PMR; nearly 1.6 times as many Filipino immigrants died of COVID-19 than was expected. Filipino immigrants also had the highest age-adjusted mortality among Asian immigrants, followed by Korean individuals. Like Vietnamese individuals, a majority of Filipino people in the U.S. are immigrants.35 Indeed, immigrants experienced greater proportionate mortality from COVID-19 relative to their U.S.-born counterparts among Hispanic and most disaggregated Asian groups. Similar trends were also seen among immigrant Non-Hispanic Black and Non-Hispanic White immigrants people when compared to their U.S.-born counterparts.

These results corroborate previous findings in California24 and Minnesota,25 which also highlight greater COVID-19 mortality among immigrants compared to U.S.-born individuals both in crude and age-adjusted rates. One possibility behind the greater burden among immigrant individuals relative to U.S.-born people may be related to the larger population of immigrants for Asian and Hispanic groups. Indeed, 57% of Asian Americans were born outside of the U.S.35 In addition, 47% of all immigrants in the U.S. identify as Hispanic, followed by 26% of Asian Americans.35 Aside from the larger population of immigrants relative to U.S.-born individuals, the higher mortality rates among immigrants compared to U.S.-born individuals could be related to the higher proportion of immigrants who work as essential workers in frontline service industries, such as medical assistants and nursing.18 For example, 1 in 20 registered nurses in the U.S. were trained in the Philippines37 and were extensively highlighted as a group that experienced COVID-19 infection and mortality.11 Additionally, structural stigma related to immigrant enforcement20 or threats of being labeled as a “public charge”18,19 may have deterred some immigrants from receiving COVID-19 preventive services until their condition became dire. In addition, some immigrants may have expressed hesitancy in receiving preventive services, like the COVID-19 vaccine, because of fears of government tracking and deportation.17,20 Finally, living in crowded multigenerational households may increase exposure to and mortality from COVID-19. Although we cannot account for decedents’ living conditions, a study of New York households found evidence that individuals who lived in overcrowded areas, in addition to people who lived in multigenerational households, had a greater risk of COVID-19.38 While these social factors may likely explain disparities in COVID-19 mortality by immigrant status, further work is needed to corroborate these findings by incorporating more comprehensive social determinants of health data.

Additionally, our age-adjusted results highlight the persistence of racial disparities in COVID-19 mortality. Hispanic and Non-Hispanic Black individuals had the highest age-adjusted mortality rates due to COVID-19 of all race groups, which corroborates with previous work.2,3,15,16 Our study highlights additional disparities in COVID-19 mortality by immigrant status. In particular, COVID-19 mortality was highest among immigrant Hispanic and Non-Hispanic Black people. Additionally, we saw persistence of the higher mortality among U.S.-born Non-Hispanic Black people. Non-Hispanic White individuals had lower mortality compared to these Hispanic and Non-Hispanic Black people, but higher mortality when compared to some Asian groups.

These findings should be taken in light of some limitations. First, the public-use nature of the mortality data prevents us from further disaggregating immigrant status into different citizenship and documentation status. Additionally, information on citizenship and documentation status are not readily recorded on the death certificate. It is possible that more marginalized immigrant groups (i.e., people who are undocumented) may have experienced disproportionate mortality compared to more established immigrant groups (i.e., naturalized citizens). Second, while we highlight Hispanic and disaggregated Asian groups, we are unable to examine other race and ethnic groups (e.g., Bangladeshi, Laotian, Pakistani). Furthermore, we were unable to examine disaggregated Hispanic groups (e.g., Cuban, Mexican, Puerto Rican) as this information was not available in public use data. Third, we used the data from the publicly available 2020 ACS as our denominator data in order to calculate our age-adjusted rates for each racial and ethnic group by immigrant status. At the time of the study, we were unable to have exact distributions from the 2020 U.S. Census. However, as a survey conducted by the U.S. Census Bureau, the ACS provides a valid substitute of estimates for our populations of interest. Fourth, while we account for differences in age structure and there may be other possible social explanations behind the higher mortality among immigrants (e.g., occupational hazards, housing conditions) that are unavailable in public use mortality data. Finally, our study only examines COVID-19 mortality as the underlying cause of death. It is possible that mortality related to COVID-19 could be far greater if COVID-19 is examined as a contributing cause.

Our study does have several notable strengths. First, we provide one of the first comprehensive national examinations of the burden of COVID-19 mortality among immigrants including disaggregated Asian groups. Previous studies have been limited to state-level and local-level samples.24,25,39 Additionally, our results highlight the heterogeneity of COVID-19 mortality among most disaggregated Asian groups. Public health and clinical efforts to address COVID-19 among these groups should consider the group-level burden among disaggregated Asian populations. Finally, our results provide some insight into the ongoing challenges immigrant communities experience with COVID-19. Clinical and public health efforts are necessary to reduce disparities with immigrant versus U.S.-born individuals.

In conclusion, our study emphasizes the disproportionate mortality from COVID-19 among immigrant populations compared to their U.S.-born counterparts. As the pandemic continues into its endemic phase, detailed surveillance of the burden of COVID-19 and mortality from COVID-19 are needed to examine if these disparities widen over time. Finally, clinical, public health, and policy efforts are needed to equitably address disparities in immigrant communities.

Supplementary Material

1

Acknowledgements

As a public use dataset, the INSTITUTION determined that study was exempt from IRB review. This study is funded in part from the Causes of Asian American mortality Understood by Socio-Economic Status (CAUSES) Study (R01MDD007012) awarded to AUTHOR 6. AUTHOR 1 was funded by the National Institutes of Health Program in the Division of Endocrinology, Gerontology, and Metabolism at the Stanford University School of Medicine T32 Program (Grant # DK007217-47). AUTHOR 6 was additionally funded by the National Heart, Lung, and Blood Institute (Grant # 1K24HL150476-01A1). The results and conclusions of the study represent the views of the authors and do not necessarily represent the views of the National Institutes of Health. AUTHORS had full access to the mortality dataset and are responsible for the integrity of the dataset, the accuracy of the data analysis, and its conclusion. AUTHOR 1 conceptualized the study, guided the data analysis, drafted the initial manuscript, and coordinated editing among authors. AUTHOR 2 cleaned the data and conducted the data analysis under the supervision of AUTHOR 1. AUTHORS contributed to the creation of tables and editing of the manuscript. AUTHORS assisted in the initial writing and critical revision of the manuscript. The authors would like to thank AUTHOR for their support in the analysis. The authors have no conflicts of interest to disclose.

Footnotes

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