Death, Inequality, and the Pandemic in the Nation's Capital

Abrupt changes in mortality rates and life expectancy allow us to understand how shocks like COVID-19 can exacerbate health inequalities across groups. We look at Washington, D.C., a major city with a diverse population and long-standing socio-economic divisions, to describe the all-cause mortality trends from 2015 to 2021 by age, sex, race, and ward of residence. We report differences in cause-specific mortality pre- and post-COVID-19 outbreak and estimate the Years of Life Lost (YLL) attributable to COVID-19. We compute death rates using information from death certificates and the Census, and we calculate YLL using the life table approach, comparing the life expectancy of people with and without COVID-19. We find that in 2020 and 2021, there were respectively 1,128 and 629 excess deaths (158 per 100K and 94 per 100K) compared to the annual average over the previous five years, and 689 and 363 deaths in 2020 and 2021, respectively (97 per 100K and 54 per 100K) listing COVID-19 as a cause of death. Death rates in 2020 and 2021, compared to the five previous years, were higher for men than women by about 12pp and 5pp and occurred almost entirely among residents 45 and older. Excess deaths between 2020 and 2021 were higher for Black and Hispanic residents by about 286 and 97 per 100K, respectively--with the highest proportional increase (almost twofold) for Hispanics in 2020. YLL was highest for Hispanic males and lowest for White females. Significance StatementThe leading causes of death in DC were historically heart disease and cancer. In 2020, the leading cause of death was COVID. Accidental and violent deaths increased dramatically and disproportionately by race. Racial disparities in COVID and non-COVID deaths indicate that these correlate with socioeconomic conditions. Life expectancy in the United States decreased for the first time in 2020 due to COVID-19. In the nations capital, the decline in life expectancy was more significant for Hispanic and non-Hispanic Black than White people, widening the already large difference in life expectancy among these groups.