Age, Sex, and Racial/Ethnic Disparities and TemporalSpatial Variation in Excess All-Cause Mortality 

During the COVID-19 Pandemic: 

Evidence from Linked Administrative 

and Census Bureau Data 

Thomas B. Foster, Leticia Fernandez, 

Sonya R. Porter, and Nikolas Pharris-Ciurej

Center for Economic Studies, U.S. Census Bureau

Tuesday, October 25, 2022

1

Disclaimer: Any opinions and conclusions expressed herein are those of the authors and do not necessarily reflect the 

views of the U.S. Census Bureau. The Census Bureau's Disclosure Review Board has reviewed this data product for 

unauthorized disclosure of confidential information and have approved the disclosure avoidance practices applied to 

this release. DRB Clearance Number: CBDRB-FY22-CES014-020.
Motivation

• In February 2022, the United States surpassed 1 million excess deaths 

since the start of the pandemic (National Center for Health Statistics 

[NCHS])

• Pandemic impacts are not distributed evenly across the population, 

but more heavily concentrated among:

• Males

• Older Americans

• Hispanic, Non-Hispanic (NH) Black, and NH American Indian/Alaskan Native 

(AIAN) individuals

• Though consensus on racial/ethnic disparities is beyond dispute, 

estimates of the relative impacts of the pandemic vary...

DRB Clearance Number: CBDRB-FY22-CES014-020. 2
Motivation

• For example:

• Polyakova et al. (2021) estimate age-adjusted excess mortality for Non-Hispanic (NH) 

Blacks is 4.2 times greater than that of NH Whites

• Luck et al. (2021) estimate age-adjusted increases in death rates are only 2.5 times 

higher for NH Blacks than NH Whites

• Variation in estimates of racial/ethnic disparities stems from differences in:

• Measurement of race/ethnicity

• Most of the literature relies on race/ethnicity as listed on death certificates

• Next-of-kin reports or coroner assessments

• Particularly poor for American Indian/Alaskan Natives (AIAN)*

• Unreliable for Hispanics, Asians, and Native Hawaiian/Pacific Islanders (NHPI)*

• Time period studied

• Trade-offs between timeliness and comprehensiveness

3

*Source: Arias et al. (2008, 2016).

DRB Clearance Number: CBDRB-FY22-CES014-020.
Goals

• Provide circumspect estimates of excess mortality in the first full year 

of the pandemic, while also examining granular variation in mortality 

for population subgroups

• Estimate age-, sex-, and race/ethnicity-specific excess all-cause mortality

• Examine racial/ethnic gaps in excess all-cause mortality over the course of the 

pandemic and across the United States

• Inform ongoing research on the determinants of pandemic-era 

disparities

DRB Clearance Number: CBDRB-FY22-CES014-020. 4
Measuring Mortality

• Census Numident (Q3 

2021)

• Universe of individuals 

ever issued a Social 

Security Number (SSN)

• Reliable date of death 

information through 

March 31, 2021* 

• Death counts and trends 

virtually identical to those 

reported by NCHS

5

12.04

10.53

9.41

10.49 10.48

9.73

10.39

11.51

13.92 14.02

10.58

10.14

6

7

8

9

10

11

12

13

14

15

Mortality per 10,000

COVID-19

(April 1, 2020 to 

March 31, 2021)

Pre-COVID-19

(April 1, 2010 to 

March 31, 2020)

*Finlay and Genadek (2021). Source: Census Numident (Q3, 2021); Decennial Census (2000, 2010); and ACS (2001-2019). Restricted to individuals 

ages 15 to 99 at the start of any given month with a non-missing self-reported or household proxy race/ethnicity response.

DRB Clearance Number: CBDRB-FY22-CES014-020.
Measuring Demographic and Geographic 

Characteristics

• Age and Sex are also drawn from the Census Numident (Q3 2021)

• We use the most recent self-reported or household-proxy 

race/ethnicity response for each individual from the decennial census 

(2000, 2010) and the American Community Survey (ACS, 2001-2019)

• Eight race/ethnicity categories following OMB (1997) standards: 

• Hispanic, NH White alone, NH Black alone, NH AIAN alone, NH Asian alone, NH NativeHawaiian/Pacific Islander (NHPI) alone, NH Some Other Race (SOR) alone, and NH 

Multiple Race

• State of last known residence:

• Decennial census (2010); ACS (2010-2019); Composite administrative record 

files (MAF-ARF, 2010-2020); and Third-party administrative data (2015-2020)

DRB Clearance Number: CBDRB-FY22-CES014-020. 6
Linkage and Universe Restrictions

• We link individuals across datasets using anonymous Protected 

Identification Keys (PIKs) assigned by the Person Identification 

Validation System (PVS) software* 

• The universe of all SSN-holders is restricted to those:

• Alive as of April 1, 2010

• With non-missing date of birth, sex, and race/ethnicity

• Ages 15 to 99 (inclusive) at the start of a given month

• Analytical universe includes 

• 2.4 billion person-month observations in the April 1, 2010 to March 31, 2020 

reference period

• 248 million person-month observations in the April 1, 2020 to March 31, 2021 

COVID period

DRB Clearance Number: CBDRB-FY22-CES014-020. 7

*Source: Wagner and Layne (2014).
Estimating Excess Mortality

• Excess Mortality = Observed 

Mortality – Expected Mortality

• Expected Mortality is the mortality 

rate expected in the hypothetical 

absence of the pandemic

• Use negative binomial regression 

(with a population offset term) to 

predict expected death counts for 

the April 1, 2020 to March 31, 2021 

period as a function of death counts 

from April 1, 2010 to March 31, 2020

• Express these expected counts as 

deaths per 10,000 person-months

8

Source: Census Numident (Q3, 2021); Decennial Census (2000, 2010); and ACS (2001-2019). Restricted to individuals ages 15 to 99 at the start of any 

given month with a non-missing self-reported or household proxy race/ethnicity response.

Observed

(11.1)

Expected

(9.3)

DRB Clearance Number: CBDRB-FY22-CES014-020.

Excess

(1.8)
13.5

7.3

11.3

7.0

10.7 10.0

5.0

9.5

4.7

3.6

3.5

2.5

2.2

1.7

1.5

1.4

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

NH AIAN Alone Hispanic NH Black Alone NH SOR Alone NH NHPI Alone NH Multiple Race NH Asian Alone NH White Alone

Mortality per 10,000 person-months

Expected

Excess

Age- and Sex-Adjusted Mortality

9

34.6%

49.1%

31.4%

35.1%

20.4%

17.3%

29.0%

14.6%

Note: National age and sex distributions are used for adjustments. Source: Census Numident (Q3, 2021); Decennial Census (2000, 2010); and ACS 

(2001-2019). Restricted to individuals ages 15 to 99 at the start of any given month with a non-missing self-reported or household proxy 

race/ethnicity response. DRB Clearance Number: CBDRB-FY22-CES014-020.

Higher Excess Mortality Lower Excess Mortality
10

Age-, Sex-, and Race/Ethnicity-Specific Excess 

Mortality

Source: Census Numident (Q3, 2021); Decennial Census (2000, 2010); and ACS (2001-2019). Restricted to individuals ages 15 to 99 at the start of any 

given month with a non-missing self-reported or household proxy race/ethnicity response. DRB Approval Number: CBDRB-FY22-CES014-020.

DRB Clearance Number: CBDRB-FY22-CES014-020.
11

Source: Census Numident (Q3, 2021); Decennial Census (2000, 2010); and ACS (2001-2019). Restricted to individuals ages 15 to 99 at the start of any 

given month with a non-missing self-reported or household proxy race/ethnicity response. 

Age-, Sex-, and Race/Ethnicity-Specific 

Proportional Excess Mortality

DRB Clearance Number: CBDRB-FY22-CES014-020.
12

Temporal-Spatial Variation in Black-White Gap

Note: Black-White gaps are raw differences in observed and expected mortality. Source: Census Numident (Q3, 2021); Decennial Census (2000, 

2010); and ACS (2001-2019). Restricted to individuals ages 15 to 99 at the start of any given month with a non-missing self-reported or household 

proxy race/ethnicity response. DRB Clearance Number: CBDRB-FY22-CES014-020.
13

Temporal-Spatial Variation in Hispanic-White Gap

Note: Hispanic-White gaps are raw differences in observed and expected mortality. Source: Census Numident (Q3, 2021); Decennial Census (2000, 

2010); and ACS (2001-2019). Restricted to individuals ages 15 to 99 at the start of any given month with a non-missing self-reported or household 

proxy race/ethnicity response. 

DRB Clearance Number: CBDRB-FY22-CES014-020.
Discussion

• National excess mortality: 1.8 per 10,000 person-months (or 216 per 

100,000 person-years)

• Adjusted excess mortality is lowest for NH Whites, but highest for NH 

AIAN, Hispanic, and NH Black individuals

• Substantial racial/ethnic variation in excess mortality at younger ages

• Racial/ethnic disparities in excess mortality 

• Widened the Black-White mortality gap in virtually all states

• Erased the Hispanic mortality advantage at the national level and, in many 

states, reversed the Hispanic-White mortality gap

DRB Clearance Number: CBDRB-FY22-CES014-020. 14
Discussion

• Limitations

• No cause of death information

• Restricted to individuals ever issued an SSN

• Substantial heterogeneity within the Hispanic racial/ethnic group

• Social and economic determinants of health as fundamental drivers 

of racial/ethnic disparities in excess mortality

• Properly understanding the origins of persistent racial/ethnic gaps 

requires accurate and detailed estimates of those gaps

DRB Clearance Number: CBDRB-FY22-CES014-020. 15
Thank you!

Contact Info:

Brad Foster

Center for Economic Studies

U.S. Census Bureau

thomas.b.foster@census.gov

DRB Clearance Number: CBDRB-FY22-CES014-020. 16
Supplemental Slides

DRB Clearance Number: CBDRB-FY22-CES014-020. 17
Motivation

18

4.17

3.6

2.73

3.38

3.09

2.4 2.45

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Polyakova et al.

(2021)

Bassett et al.

(2020)

Goldstein and

Atherwood

(2020)

Arias et al. (2021) Andrasfay and

Goldman (2020)

Woolf et al.

(2021)

Luck et al. (2021)

Age-adjusted

excess mortality

Age-standardized COVID-19

mortality

Decline in Life Expectancy Increase in AgeStandardized

Death Rate

Ratio of Black to White 

Pandemic Mortality Outcomes

Source: Author tabulations of findings reported by Polyakova et al. (2021), Basset et al. (2020), Goldstein and Atherwood (2020), Arias et al. (2021), 

Andrasfay and Goldman (2020) Woolf et al. (2021), and Luck et al. (2021). Our estimates come from Census Numident (Q3, 2021); Decennial Census 

(2000, 2010); and ACS (2001-2019). Restricted to individuals ages 15 to 99 at the start of any given month with a non-missing self-reported or 

household proxy race/ethnicity response -- DRB Approval Number: CBDRB-FY22-CES014-020.

April 2020

Through May of 2020

Six months of 

2020 data

All of 2020

DRB Clearance Number: CBDRB-FY22-CES014-020.
Excess Mortality by Sex and Age

19

1.6

2.1

0.0

0.5

1.0

1.5

2.0

2.5

Females Males

Excess Mortality per 10,000 person-months

0.1 0.1 0.2 0.2 0.3 0.5 0.7 0.8 1.0

1.7

2.7

4.1

6.9

10.7

15.2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Excess Mortality per 10,000 person-months

Source: Census Numident (Q3, 2021); Decennial Census (2000, 2010); and ACS (2001-2019). Restricted to individuals ages 15 to 99 at the start of any 

given month with a non-missing self-reported or household proxy race/ethnicity response. 

DRB Clearance Number: CBDRB-FY22-CES014-020.
Temporal Trends in Age-Adjusted Excess 

Mortality

DRB Clearance Number: CBDRB-FY22-CES014-020. 20

Source: Census Numident (Q3, 2021); Decennial Census (2000, 2010); and ACS (2001-2019). Restricted to individuals ages 15 to 99 at the start of any 

given month with a non-missing self-reported or household proxy race/ethnicity response. 
Racial/Ethnic 

Gaps in Excess 

Mortality by 

Month

DRB Clearance Number: CBDRB-FY22-CES014-020. 21

Source: Census Numident (Q3, 2021); Decennial Census (2000, 2010); and ACS (2001-2019). Restricted to individuals ages 15 to 99 at the start of any 

given month with a non-missing self-reported or household proxy race/ethnicity response. 
TemporalSpatial 

Trends in 

Excess 

Mortality

DRB Clearance Number: CBDRB-FY22-CES014-020. 22

Source: Census Numident (Q3, 2021); Decennial Census (2000, 2010); and ACS (2001-2019). Restricted to individuals ages 15 to 99 at the start of any 

given month with a non-missing self-reported or household proxy race/ethnicity response.