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

Objectives This study describes trends in all-cause mortality and Years of Life Lost (YLL) before and after COVID-19 in Washington, DC, disaggregated by age, sex, race, and ward of residence as a proxy for socioeconomic status. Methods We obtained mortality data from DC’s death records and calculated sex-age-race-specific death rates using information from the census and YLL using the life table approach and the difference in life expectancy between people with and without a COVID-19 diagnosis. Results In 2020 there were 990 more deaths (139 per 100K) in the capital compared to the annual average over the previous five years, and 676 of these deaths (94.8 per 100K) listed COVID-19 as one of the causes of death. Excess deaths in 2020 were higher in April, May, and December than in other months by 100-300 deaths; were higher for men than women by about 10.2%, and occurred almost entirely among residents 55 and older. Moreover, excess deaths were higher for those identified as Black or Hispanic by about 300 or 150 per 100K, respectively—the highest proportional increase (almost twofold) for Hispanics in 2020 compared to the five previous years. Additionally, neighborhood differences reflect ethnic and socioeconomic inequality: increases in mortality during 2020 were most significant for those wards with the most Black and Hispanic residents and the lowest income and employment rates, corresponding with historical trends in illness and mortality. Indicating the intersectionality of these differences, in 2020, Black and Hispanic males lost 6 and 7 expected years of life, respectively, and Black and Hispanic females lost 5 and 6 years, respectively. In contrast, Whites lost no years of life during the pandemic. Conclusion Examining mortality rates and life expectancy within population subgroups and using ward-level data allows us to understand how the pandemic has exacerbated health inequalities. Local-level sociodemographic research like ours reveals intersectional inequalities often obscured by the national statistics often used in popular and scholarly discourse. Our findings should promote actionable local policy to decrease YLL from preventable deaths and earlier mortality from COVID-19 among disadvantaged groups. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the National Institute of Allergy and Infectious Diseases (project number 1R03AI163978-01A1). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of Georgetown University (STUDY00002853) and the Institutional Review Board at the DC Department of Health (IRBPH # 2020-11) gave ethical approval for this work as Exempt from Research. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data in the present study were obtained from the Department of Vital Records in Washington, DC. These data are proprietary and will not be shared by the authors; we encourage interested parties to contact the Department of Vital Records regarding data access.