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Gebreegziabher E, Bui D, Cummings KJ, Frederick M, Nguyen A, Collins C, Melton D, Yang A, Jain S, Vergara X. Demographic changes in COVID-19 mortality during the pandemic: analysis of trends in disparities among workers using California's mortality surveillance system. BMC Public Health 2024; 24:1822. [PMID: 38977988 PMCID: PMC11232202 DOI: 10.1186/s12889-024-19257-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND There is limited information on the extent and patterns of disparities in COVID-19 mortality throughout the pandemic. We aimed to examine trends in disparities by demographics over variants in the pre- and post-vaccine availability period among Californian workers using a social determinants of health lens. METHODS Using death certificates, we identified all COVID-19 deaths that occurred between January 2020 and May 2022 among workers aged 18-64 years in California (CA). We derived estimates for at-risk worker populations using the Current Population Survey. The waves of COVID-19 mortality in the pre-vaccine availability period were March 2020-June 2020 (wave 1), and July 2020-November 2020 (wave 2), and in the post-vaccine availability period: December 2020-May 2021 (wave 3), June 2021-January 2022 (wave 4), and February 2022-May 2022 (wave 5). Poisson regression models with robust standard errors were used to determine wave-specific mortality rate ratios (MRRs). We examined the change in MRR across waves by including an interaction term between each demographic characteristic and wave period in different models. The role of potential misclassification of Race/ethnicity on death certificates was examined using probabilistic quantitative bias analysis as sensitivity analysis. RESULTS Among the 24.1 million working age CA population included in the study, there were 26,068 COVID-19 deaths in the period between January 2020 and May 2022. Compared with their respective reference groups, workers who were 50-64 years old, male, Native Hawaiian, Latino, or African American, foreign-born; individuals who had lower education; and unmarried were disproportionately affected by COVID-19 mortality. While disparities by sex, race/ethnicity and foreign-born status narrowed in later waves (post-vaccine availability), disparities by age, education level and marital status did not change substantially across waves. CONCLUSION Demographic disparities in COVID-19 mortality narrowed in the post-vaccine availability waves. However, the existence of disparities across all waves of the pandemic, even in an era of widespread vaccine coverage, could indicate remaining gaps in prevention and differential vulnerability. Addressing the underlying social, structural, and occupational factors that contribute to these disparities is critical for achieving health equity.
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Affiliation(s)
- Elisabeth Gebreegziabher
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA, 94804, USA.
- Heluna Health, 13300 Crossroads Pkwy. N #450, City of Industry, CA, 91746, USA.
| | - David Bui
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA, 94804, USA
- Heluna Health, 13300 Crossroads Pkwy. N #450, City of Industry, CA, 91746, USA
| | - Kristin J Cummings
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA, 94804, USA
| | - Matthew Frederick
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA, 94804, USA
- Public Health Institute, Oakland, CA, 94607, USA
| | - Alyssa Nguyen
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, 94804, USA
| | - Caroline Collins
- Heluna Health, 13300 Crossroads Pkwy. N #450, City of Industry, CA, 91746, USA
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, 94804, USA
| | - David Melton
- Heluna Health, 13300 Crossroads Pkwy. N #450, City of Industry, CA, 91746, USA
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, 94804, USA
| | - Alice Yang
- Heluna Health, 13300 Crossroads Pkwy. N #450, City of Industry, CA, 91746, USA
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, 94804, USA
| | - Seema Jain
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, 94804, USA
| | - Ximena Vergara
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA, 94804, USA
- Heluna Health, 13300 Crossroads Pkwy. N #450, City of Industry, CA, 91746, USA
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Wagner GR, Michaels D. Work Matters: Mainstreaming Worker Health and Safety Is Not Limited to Pandemic Response. Am J Public Health 2024; 114:372-376. [PMID: 38359381 PMCID: PMC10937612 DOI: 10.2105/ajph.2023.307565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Affiliation(s)
- Gregory R Wagner
- Gregory R. Wagner is with the Harvard T. H. Chan School of Public Health, Boston, MA. David Michaels is with the George Washington University Milken Institute School of Public Health, Washington, DC
| | - David Michaels
- Gregory R. Wagner is with the Harvard T. H. Chan School of Public Health, Boston, MA. David Michaels is with the George Washington University Milken Institute School of Public Health, Washington, DC
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Michaels D, Spieler EA, Wagner GR. US workers during the covid-19 pandemic: uneven risks, inadequate protections, and predictable consequences. BMJ 2024; 384:e076623. [PMID: 38286467 DOI: 10.1136/bmj-2023-076623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Affiliation(s)
- David Michaels
- Milken Institute School of Public Heath, George Washington University, Washington, DC, USA
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