The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups
in the United States. Whereas racial and ethnic disparities in severe COVID-19–associated
outcomes, including mortality, have been documented (
1
–
3
), less is known about population-based disparities in infection with SARS-CoV-2,
the virus that causes COVID-19. In addition, although persons aged <30 years account
for approximately one third of reported infections,
§
there is limited information on racial and ethnic disparities in infection among young
persons over time and by sex and age. Based on 689,672 U.S. COVID-19 cases reported
to CDC’s case-based surveillance system by jurisdictional health departments, racial
and ethnic disparities in COVID-19 incidence among persons aged <25 years in 16 U.S.
jurisdictions
¶
were described by age group and sex and across three periods during January 1–December
31, 2020. During January–April, COVID-19 incidence was substantially higher among
most racial and ethnic minority groups compared with that among non-Hispanic White
(White) persons (rate ratio [RR] range = 1.09–4.62). During May–August, the RR increased
from 2.49 to 4.57 among non-Hispanic Native Hawaiian and Pacific Islander (NH/PI)
persons but decreased among other racial and ethnic minority groups (RR range = 0.52–2.82).
Decreases in disparities were observed during September–December (RR range = 0.37–1.69);
these decreases were largely because of a greater increase in incidence among White
persons, rather than a decline in incidence among racial and ethnic minority groups.
NH/PI, non-Hispanic American Indian or Alaska Native (AI/AN), and Hispanic or Latino
(Hispanic) persons experienced the largest persistent disparities over the entire
period. Ensuring equitable and timely access to preventive measures, including testing,
safe work and education settings, and vaccination when eligible is important to address
racial/ethnic disparities.
Population-based COVID-19 incidence (cases per 100,000 persons) by race and ethnicity,
sex, and age was calculated for January 1–December 31, 2020, overall, and for three
approximately equal 4-month periods (January 1–April 30, May 1–August 31, and September
1–December 31) using COVID-19 cases reported to CDC’s case-based surveillance system**
by jurisdictional health departments. Incompleteness of race and ethnicity data is
a widespread challenge in analyses of COVID-19 disparities.
††
To minimize the impact of missing data, jurisdictions selected for analyses reported
≥30% of the total number of jurisdictional aggregate cases
§§
to CDC and had ≥70% of race and ethnicity information complete among cases reported
during January 1–December 31, 2020. Fifteen U.S. states and the District of Columbia
were included, with a total of 689,672 cases among persons aged <25 years with information
on race and ethnicity and sex.
¶¶
Population denominators were obtained from the 2019 U.S. Census Bureau’s Annual County
Resident Population Estimates by Age, Sex, Race, and Hispanic Origin.***
Seven racial and ethnic categories (AI/AN, non-Hispanic Asian [Asian], non-Hispanic
Black or African-American [Black], NH/PI, White, Hispanic, and non-Hispanic multiple
race [multiracial]) and five age categories (0–4, 5–9, 10–14, 15–19, and 20–24 years)
were examined. RRs with 95% confidence intervals (CIs) comparing rates by race and
ethnicity (combined), age, and/or sex overall and for each period were calculated.
Statistical analyses were conducted using SAS software (version 9.4; SAS Institute).
Rate ratios with 95% CIs excluding 1.0 were considered to be statistically significant.
This activity was reviewed by CDC and was conducted consistent with applicable federal
law and CDC policy.
†††
The sample of 689,672 cases included 15,068 (2%) cases identified during January–April;
177,778 (26%) during May–August and 496,826 (72%) during September–December (Table
1). During January–April, COVID-19 incidence ranged from 35 cases per 100,000 among
White persons to 163 per 100,000 among AI/AN persons. Compared with White persons,
rates were higher among AI/AN (RR = 4.62), Hispanic (RR = 3.87), NH/PI (RR = 2.49),
Black (RR = 2.46), and Asian persons (RR = 1.53) and were approximately equal among
multiracial persons (RR = 1.09).
TABLE 1
COVID–19 incidence* and rate ratios, by race/ethnicity, sex, and age group among persons
aged <25 years across three periods — 16 U.S. jurisdictions,
†
January 1–December 31, 2020
Date/Characteristic
No. of cases
Cases per 100,000 population (95% CI)
RR (95% CI)
January 1–April 30, 2020
All
15,068
63 (62–64)
—
Sex
Male
6,884
57 (55–58)
0.80 (0.78–0.83)
Female
8,184
70 (69–72)
Ref
Race/Ethnicity
AI/AN, non-Hispanic
536
163 (150–177)
4.62 (4.22–5.05)
Asian, non-Hispanic
498
54 (49–59)
1.53 (1.39–1.67)
Black, non-Hispanic
2,461
87 (83–90)
2.46 (2.34–2.58)
NH/PI, non-Hispanic
73
88 (70–111)
2.49 (1.98–3.14)
White, non-Hispanic
4,947
35 (34–36)
Ref
Hispanic/Latino
6,129
137 (133–140)
3.87 (3.73–4.02)
Multiple, non-Hispanic
424
38 (35–42)
1.09 (0.98–1.20)
Age group (yrs)
0–4
956
21 (20–23)
1.28 (1.17–1.41)
5–9
772
17 (16–18)
Ref
10–14
1,184
25 (23–26)
1.49 (1.36–1.63)
15–19
3,267
67 (65–70)
4.03 (3.72–4.36)
20–24
8,889
175 (171–178)
10.47 (9.72–11.26)
May 1–August 31, 2020
All
177,778
747 (744–751)
—
Sex
Male
84,270
693 (688–698)
0.86 (0.85–0.87)
Female
93,508
804 (799–809)
Ref
Race/Ethnicity
AI/AN, non-Hispanic
3,245
986 (952–1,020)
1.86 (1.80–1.93)
Asian, non-Hispanic
3,781
409 (396–422)
0.77 (0.75–0.80)
Black, non-Hispanic
24,501
862 (852–873)
1.63 (1.61–1.65)
NH/PI, non-Hispanic
2,007
2,418 (2,314–2,526)
4.57 (4.37–4.77)
White, non-Hispanic
74,259
530 (526–533)
Ref
Hispanic/Latino
66,938
1,493 (1,481–1,504)
2.82 (2.79–2.85)
Multiple, non-Hispanic
3,047
275 (266–285)
0.52 (0.50–0.54)
Age group (yrs)
0–4
14,017
314 (309–319)
1.01 (0.98–1.03)
5–9
14,406
312 (307–317)
Ref
10–14
20,490
430 (424–436)
1.38 (1.35–1.41)
15–19
50,210
1,034 (1,025–1,043)
3.32 (3.26–3.38)
20–24
78,655
1,547 (1,536–1,557)
4.96 (4.88–5.05)
September 1–December 31, 2020
All
496,826
2,088 (2,082–2,094)
—
Sex
Male
236,237
1,943 (1,935–1,951)
0.87 (0.86–0.87)
Female
260,589
2,240 (2,231–2,248)
Ref
Race/Ethnicity
AI/AN, non-Hispanic
11,870
3,605 (3,541–3,671)
1.62 (1.59–1.65)
Asian, non-Hispanic
11,680
1,263 (1,240–1,286)
0.57 (0.56–0.58)
Black, non-Hispanic
32,200
1,133 (1,121–1,146)
0.51 (0.50–0.52)
NH/PI, non-Hispanic
3,119
3,757 (3,628–3,891)
1.69 (1.63–1.75)
White, non-Hispanic
311,591
2,222 (2,214–2,230)
Ref
Hispanic/Latino
117,305
2,616 (2,601–2,631)
1.18 (1.17–1.19)
Multiple, non-Hispanic
9,061
819 (803–836)
0.37 (0.36–0.38)
Age group (yrs)
0–4
33,595
752 (744–760)
0.71 (0.70–0.72)
5–9
48,824
1,056 (1,047–1,066)
Ref
10–14
76,922
1,615 (1,604–1,627)
1.53 (1.51–1.55)
15–19
149,660
3,083 (3,067–3,098)
2.92 (2.89–2.95)
20–24
187,825
3,693 (3,677–3,710)
3.50 (3.46–3.53)
January 1–December 31, 2020
All
689,672
2,899 (2,892–2,906)
—
Sex
Male
327,391
2,693 (2,684–2,702)
0.86 (0.86–0.87)
Female
362,281
3,114 (3,104–3,124)
Ref
Race/Ethnicity
AI/AN, non-Hispanic
15,651
4,754 (4,680–4,829)
1.71 (1.68–1.73)
Asian, non-Hispanic
15,959
1,725 (1,699–1,752)
0.62 (0.61–0.63)
Black, non-Hispanic
59,162
2,083 (2,066–2,099)
0.75 (0.74–0.75)
NH/PI, non-Hispanic
5,199
6,263 (6,095–6,436)
2.25 (2.19–2.31)
White, non-Hispanic
390,797
2,787 (2,778–2,795)
Ref
Hispanic/Latino
190,372
4,245 (4,226–4,264)
1.52 (1.52–1.53)
Multiple, non-Hispanic
12,532
1,133 (1,113–1,153)
0.41 (0.40–0.41)
Age group (yrs)
0–4
48,568
1,087 (1,078–1,097)
0.79 (0.78–0.79)
5–9
64,002
1,385 (1,374–1,395)
Ref
10–14
98,596
2,070 (2,057–2,083)
1.50 (1.48–1.51)
15–19
203,137
4,184 (4,166–4,202)
3.02 (2.99–3.05)
20–24
275,369
5,415 (5,394–5,435)
3.91 (3.88–3.94)
Abbreviations: AI/AN = American Indian or Alaska Native; CI = confidence interval;
NH/PI = Native Hawaiian and Pacific Islander; Ref = referent group; RR = rate ratio.
* Rates for each period and for the full period were calculated using the following
equation: (cases/population) x 100,000 persons. COVID–19 cases were identified using
CDC’s Data Collation and Integration for Public Health Event Response system (https://data.cdc.gov/browse?tags=covid-19
[accessed January 27, 2021]). Case surveillance data were received directly from two
jurisdictional health departments (Hawaii State Department of Health and New Mexico
Department of Health) for all racial/ethnic groups to allow for separate reporting
of NH/PI persons. Population estimates were provided by the 2019 U.S. Census Bureau’s
Annual County Resident Population Estimates by Age, Sex, Race, and Hispanic Origin
(https://www.census.gov/programs-surveys/popest/technical-documentation/file-layouts.html
[accessed August 20, 2020]). 2019 population estimates in the 16 selected jurisdictions
were as follows: persons aged <25 years: all (23,792,864), males (12,157,933), females
(11,634,931), non-Hispanic AI/AN (329,235), non-Hispanic Asian (925,072), non-Hispanic
Black or African-American (2,840,777), non-Hispanic NH/PI (83,012), non-Hispanic White
(14,024,304), Hispanic or Latino (4,484,434), and non-Hispanic persons of multiple
races (1,106,030); and persons aged 0–4 years (4,467,369), 5–9 years (4,622,261),
10–14 years (4,762,433), 15–19 years (4,855,127), and 20–24 years (5,085,674). No
measures were calculated for non-Hispanic persons of other races with COVID-19 (n
= 19,627) because of lack of population denominator information from U.S. Census Bureau.
† Arkansas, District of Columbia, Florida, Hawaii, Kansas, Kentucky, Maine, Massachusetts,
Michigan, Minnesota, New Mexico, Oklahoma, Oregon, Utah, Vermont, and Wisconsin.
From January–April to May–August, COVID-19 incidence increased among all racial and
ethnic groups, ranging from 275 per 100,000 among multiracial persons to 2,418 per
100,000 among NH/PI persons. The largest relative increase occurred among NH/PI persons,
with incidence increasing 26-fold, from 88 to 2,418 per 100,000. Rate ratios increased
among NH/PI persons but decreased among other racial and ethnic minority groups. During
May–August, compared with that among White persons, incidence remained higher among
NH/PI (RR = 4.57), Hispanic (RR = 2.82), AI/AN (RR = 1.86), and Black persons (RR = 1.63),
but was lower among Asian (RR = 0.77) and multiracial persons (RR = 0.52).
From May–August to September–December, COVID-19 incidence increased among all racial
and ethnic groups. The largest relative increase occurred among White persons, with
incidence increasing approximately 320%, from 530 to 2,222 cases per 100,000 from
May–August to September–December. Disparities decreased among all racial and ethnic
minority groups. During September–December, compared with that among White persons,
incidence remained higher among NH/PI (RR = 1.69), AI/AN (RR = 1.62), and Hispanic
persons (RR = 1.18), but was lower among Asian (RR = 0.57), Black (RR = 0.51), and
multiracial persons (RR = 0.37).
Incidence was higher among females than among males during all of 2020 and across
periods. Incidence also tended to be lowest among younger children across periods.
Lowest incidence was observed among children aged 5–9 years during January–April,
those aged 0–9 years during May–August, and those aged 0–4 years during September–December.
During January–December, overall, the highest COVID-19 incidence relative to that
among White persons was among NH/PI persons of most age groups, with the largest differences
among those aged 0–4 (RR = 4.03) and 5–9 years (RR = 3.21) (Figure) (Supplementary
Table, https://stacks.cdc.gov/view/cdc/103733). During January–December, among persons
aged ≤14 years, incidence relative to White persons was initially higher among Black
and Asian persons and persistently higher among NH/PI, AI/AN, and Hispanic persons;
among persons aged 15–24 years, incidence relative to White persons was initially
higher among Black, Asian, and multiracial persons, and persistently higher among
NH/PI, AI/AN, and Hispanic persons. Overall, during January–December, differences
compared with White persons among AI/AN, NH/PI, and Hispanic persons were larger in
persons aged ≤14 years than among those aged 15–24 years. Racial and ethnic disparities
were similar in magnitude and direction for both females and males across age groups
(Table 2).
FIGURE
Rate ratios* comparing COVID-19 incidence
†
among racial and ethnic minority persons to COVID-19 incidence among non-Hispanic
White persons, among persons aged <25 years, by age group in three periods — 16 U.S.
jurisdictions,
§
January 1–December 31, 2020
Abbreviations: AI/AN=American Indian or Alaska Native; NH/PI=Native Hawaiian and Pacific
Islander; ref = referent group.
* Rate ratios were calculated during each period and overall. Data used to generate
this figure are included in the Supplementary Table, https://stacks.cdc.gov/view/cdc/103733.
Rate ratios are not available in situations where data were suppressed because of
<20 cases being reported for a given race/ethnicity and age group during a period.
During January 1–April 30, 2020, <20 cases were reported for non-Hispanic NH/PI persons
aged 0–4, 5–9, 10–14, and 15–19 years. Rate ratios were similar and thus corresponding
rate ratio symbols overlap in the figure for the following categories: AI/AN persons
aged 15–19 and 20–24 years during May 1–August 31 and September 1–December 31; Black
persons aged 5–9 years during January 1–April 30 and May 1–August 31; and NH/PI persons
aged 20–24 years during January 1–April 30 and September 1–December 31.
† Rates for each period and for the full period were calculated using the following
equation: (cases/population) x 100,000 persons. COVID-19 cases were identified using
CDC’s Data Collation and Integration for Public Health Event Response system (https://data.cdc.gov/browse?tags=covid-19
[accessed January 27, 2021]). Case surveillance data were received directly from two
jurisdictional health departments (Hawaii State Department of Health and New Mexico
Department of Health) for all racial/ethnic groups to allow for separate reporting
of NH/PI persons. Population estimates were provided by the 2019 U.S. Census Bureau’s
Annual County Resident Population Estimates by Age, Sex, Race, and Hispanic Origin
(https://www.census.gov/programs-surveys/popest/technical-documentation/file-layouts.html
[accessed August 20, 2020]).
§ Arkansas, District of Columbia, Florida, Hawaii, Kansas, Kentucky, Maine, Massachusetts,
Michigan, Minnesota, New Mexico, Oklahoma, Oregon, Utah, Vermont, and Wisconsin.
The figure is a scatter plot showing the rate ratios comparing COVID-19 incidence
among racial and ethnic minority persons to COVID-19 incidence among non-Hispanic
White persons, among persons aged <25 years, by age group in three periods, in 16
U.S. jurisdictions, during January 1–December 31, 2020.
TABLE 2
Sex-specific COVID-19 incidence* and rate ratios among persons aged <25 years, by
age group, sex, and race/ethnicity — 16 U.S. jurisdictions,
†
January 1–December 31, 2020
Age group, race/ethnicity
Sex
Female
Male
No. of cases
Cases per 100,000 population (95% CI)
Rate ratio (95% CI)
No. of cases
Cases per 100,000 population (95% CI)
Rate ratio (95% CI)
0–4 yrs
All
23,272
1,067 (1,053–1,081)
—
25,296
1,107 (1,093–1,120)
—
AI/AN, non-Hispanic
658
2,247 (2,082–2,425)
2.69 (2.49–2.91)
677
2,208 (2,048–2,381)
2.54 (2.35–2.75)
Asian, non-Hispanic
642
858 (794–927)
1.03 (0.95–1.11)
721
913 (849–982)
1.05 (0.98–1.13)
Black, non-Hispanic
2,541
940 (904–977)
1.13 (1.08–1.18)
2,844
1,028 (991–1,067)
1.18 (1.14–1.23)
NH/PI, non-Hispanic
266
3,576 (3,171–4,033)
4.28 (3.79–4.83)
258
3,306 (2,926–3,735)
3.81 (3.37–4.31)
White, non-Hispanic
10,391
835 (820–852)
Ref
11,382
868 (852–884)
Ref
Hispanic/Latino
8,299
1,901 (1,861–1,943)
2.28 (2.21–2.34)
8,889
1,951 (1,910–1,992)
2.25 (2.19–2.31)
Multiple, non-Hispanic
475
399 (365–436)
0.48 (0.44–0.52)
525
420 (386–458)
0.48 (0.44–0.53)
5–9 yrs
All
31,333
1,389 (1,374–1,404)
—
32,669
1,381 (1,366–1,396)
—
AI/AN, non-Hispanic
917
2,901 (2,719–3,095)
2.40 (2.24–2.56)
941
2,861 (2,684–3,050)
2.39 (2.24–2.56)
Asian, non-Hispanic
741
904 (841–971)
0.75 (0.69–0.80)
890
1,048 (981–1,119)
0.88 (0.82–0.94)
Black, non-Hispanic
3,019
1,081 (1,043–1,120)
0.89 (0.86–0.93)
3,155
1,096 (1,058–1,135)
0.92 (0.88–0.95)
NH/PI, non-Hispanic
287
3,676 (3,275–4,127)
3.04 (2.70–3.42)
326
4,040 (3,624–4,503)
3.38 (3.03–3.77)
White, non-Hispanic
15,609
1,210 (1,191–1,229)
Ref
16,280
1,195 (1,177–1,214)
Ref
Hispanic/Latino
10,174
2,271 (2,227–2,315)
1.88 (1.83–1.92)
10,564
2,264 (2,221–2,308)
1.89 (1.85–1.94)
Multiple, non-Hispanic
586
501 (462–543)
0.41 (0.38–0.45)
513
414 (380–452)
0.35 (0.32–0.38)
10–14 yrs
All
49,235
2,112 (2,094–2,131)
—
49,361
2,030 (2,012–2,048)
—
AI/AN, non-Hispanic
1,477
4,461 (4,239–4,694)
2.31 (2.19–2.44)
1,520
4,492 (4,272–4,723)
2.42 (2.30–2.55)
Asian, non-Hispanic
949
1,089 (1,022–1,160)
0.56 (0.53–0.60)
1,066
1,210 (1,140–1,285)
0.65 (0.61–0.69)
Black, non-Hispanic
4,192
1,510 (1,465–1,556)
0.78 (0.76–0.81)
4,042
1,416 (1,373–1,461)
0.76 (0.74–0.79)
NH/PI, non-Hispanic
424
4,803 (4,367–5,283)
2.49 (2.26–2.74)
445
4,779 (4,355–5,245)
2.58 (2.35–2.83)
White, non-Hispanic
26,147
1,930 (1,907–1,954)
Ref
26,360
1,853 (1,831–1,876)
Ref
Hispanic/Latino
15,128
3,335 (3,282–3,389)
1.73 (1.69–1.76)
15,020
3,175 (3,125–3,226)
1.71 (1.68–1.75)
Multiple, non-Hispanic
918
794 (744–847)
0.41 (0.39–0.44)
908
760 (712–811)
0.41 (0.38–0.44)
15–19 yrs
All
109,350
4,601 (4,574–4,628)
—
93,787
3,784 (3,760–3,808)
—
AI/AN, non-Hispanic
2,432
7,218 (6,937–7,511)
1.55 (1.49–1.61)
1,971
5,634 (5,391–5,889)
1.54 (1.47–1.61)
Asian, non-Hispanic
2,133
2,181 (2,090–2,275)
0.47 (0.45–0.49)
1,960
2,065 (1,975–2,158)
0.56 (0.54–0.59)
Black, non-Hispanic
8,056
2,915 (2,852–2,979)
0.63 (0.61–0.64)
7,774
2,715 (2,655–2,776)
0.74 (0.72–0.76)
NH/PI, non-Hispanic
715
8,679 (8,066–9,339)
1.86 (1.73–2.01)
633
7,253 (6,709–7,840)
1.98 (1.83–2.14)
White, non-Hispanic
66,431
4,655 (4,620–4,691)
Ref
54,869
3,661 (3,630–3,691)
Ref
Hispanic/Latino
27,571
6,361 (6,286–6,436)
1.37 (1.35–1.39)
24,846
5,497 (5,430–5,566)
1.50 (1.48–1.52)
Multiple, non-Hispanic
2,012
2,010 (1,924–2,100)
0.43 (0.41–0.45)
1,734
1,689 (1,612–1,771)
0.46 (0.44–0.48)
20–24 yrs
All
149,091
5,987 (5,957–6,018)
—
126,278
4,865 (4,839–4,892)
—
AI/AN, non-Hispanic
2,881
8,386 (8,086–8,698)
1.43 (1.38–1.48)
2,177
6,253 (5,995–6,521)
1.34 (1.29–1.40)
Asian, non-Hispanic
3,558
2,997 (2,900–3,097)
0.51 (0.49–0.53)
3,299
2,805 (2,711–2,903)
0.60 (0.58–0.62)
Black, non-Hispanic
12,708
4,316 (4,241–4,391)
0.74 (0.72–0.75)
10,831
3,534 (3,468–3,601)
0.76 (0.74–0.78)
NH/PI, non-Hispanic
941
11,453 (10,744–12,209)
1.95 (1.83–2.08)
904
10,546 (9,880–11,256)
2.27 (2.12–2.42)
White, non-Hispanic
89,490
5,867 (5,829–5,906)
Ref
73,838
4,649 (4,615–4,682)
Ref
Hispanic/Latino
36,744
8,775 (8,685–8,865)
1.50 (1.48–1.51)
33,137
7,418 (7,339–7,499)
1.60 (1.58–1.62)
Multiple, non-Hispanic
2,769
3,059 (2,947–3,175)
0.52 (0.50–0.54)
2,092
2,251 (2,156 –2,349)
0.48 (0.46–0.51)
Abbreviations: AI/AN = American Indian or Alaska Native; CI = confidence interval;
NH/PI = Native Hawaiian and Pacific Islander; Ref = referent group.
* Rates for each period and for the full period were calculated using the following
equation: (cases/population) x 100,000 persons. COVID-19 cases were identified using
CDC’s Data Collation and Integration for Public Health Event Response system (https://data.cdc.gov/browse?tags=covid-19
[accessed January 27, 2021]). Case surveillance data were received directly from two
jurisdictional health departments (Hawaii State Department of Health and New Mexico
Department of Health) for all racial/ethnic groups to allow for separate reporting
of NH/PI persons. Population estimates were provided by the 2019 U.S. Census Bureau’s
Annual County Resident Population Estimates by Age, Sex, Race, and Hispanic Origin
(https://www.census.gov/programs-surveys/popest/technical-documentation/file-layouts.html
[accessed August 20, 2020]).
† Arkansas, District of Columbia, Florida, Hawaii, Kansas, Kentucky, Maine, Massachusetts,
Michigan, Minnesota, New Mexico, Oklahoma, Oregon, Utah, Vermont, and Wisconsin.
Discussion
Analysis of CDC’s case-based surveillance data in 16 U.S. jurisdictions during January–December
2020 indicates that racial and ethnic differences in COVID-19 incidence among persons
aged <25 years changed over time. Disparities were substantial early in the pandemic
among most racial and ethnic minority groups compared with White persons and then
decreased over time, largely because of a greater increase in incidence among White
persons. Among NH/PI persons, disparities increased from January–April to May–August
and then decreased by September–December. The largest persistent disparities in COVID-19
incidence were among NH/PI, AI/AN, and Hispanic persons. Other studies have reported
disproportionately higher percentages of COVID-19 cases among Hispanic, Black, Asian,
and AI/AN children (
4
,
5
); however, no published studies to date have described national COVID-19 incidence
among NH/PI children.
Social determinants of health influence racial and ethnic disparities in case incidence.
§§§
The large racial and ethnic COVID-19 disparities identified early in the pandemic
in this analysis might reflect differential ability to participate in early mitigation
measures, such as stay-at-home orders (
6
). Racial and ethnic minority groups are disproportionately represented in essential
work settings, making it difficult for youths and parents to stay at home; a higher
likelihood of living in a multigenerational household also increases the risk for
household exposures to SARS-CoV-2.
¶¶¶
For example, NH/PI persons, a group with some of the largest persistent disparities
in this analysis, most often reside in multigenerational homes compared with other
racial and ethnic groups (
7
). Despite on average having lower income and educational attainment, NH/PI persons
are often grouped in analyses with Asian persons (
8
), thereby obscuring disparities influenced by these social determinants of health.
The decrease in racial and ethnic disparities observed over time was largely driven
by a greater increase in COVID-19 incidence among White persons, rather than a decrease
among racial and ethnic minority groups. This narrowing in differences should be considered
in the context of geographic aspects of community spread over time and potential changes
in access to or participation in mitigation measures or testing over time by race
and ethnicity. For example, future studies could consider whether variations in state-mandated
mitigation policies and other aspects of the policy environment led to the observed
differential adherence in some mitigation measures by race/ethnicity (
9
). Further study of whether some testing strategies (e.g., repeat testing of students
in some academic settings****) might have been differentially available by race and
ethnicity over time is also needed.
The findings in this report are subject to at least five limitations. First, reporting
of detailed case data and race and ethnicity to CDC is incomplete. Although this analysis
was restricted to 16 jurisdictions with more complete case and race and ethnicity
information, 23% of cases from these jurisdictions were missing data on race and ethnicity.
Differences in data completeness by race and ethnicity could lead to underestimation
of disparities (
10
). Restriction to 16 jurisdictions also limits the generalizability of these findings,
because they are based on only 23% of the national population of persons aged <25
years; in addition, disparities could vary at geographic subdivisions within states.
Second, these data likely underestimate the incidence of COVID-19 among persons aged
<25 years because individual-level cases reported to CDC represent a portion of jurisdictional
aggregate cases and asymptomatic persons are less likely to be tested. Third, cases
among racial and ethnic minority groups might be disproportionately underreported
given disparities in access to testing, leading to underestimation of disparities.
Fourth, potential differences in testing, reporting, and completeness of data by race
and ethnicity over time call for caution in interpretation of the observed changes
in racial and ethnic disparities in this report. Finally, racial and ethnic disparities
in COVID-19 incidence (and changes over time) might not reflect disparities in severe
outcomes (
1
–
3
).
††††
During January 1–December 31, 2020, substantial racial and ethnic disparities in COVID-19
incidence, observed early in the pandemic among persons aged <25 years in 16 jurisdictions,
decreased over time, driven largely by a greater increase in reporting of cases among
White persons. The largest persistent disparities were among NH/PI, AI/AN, and Hispanic
persons. Ensuring equitable and timely access to preventive measures, including testing,
safe work and education settings and vaccination when eligible is important to address
racial/ethnic disparities.
§§§§
Summary
What is already known about this topic?
U.S. racial and ethnic minority groups have been disproportionately affected by COVID-19.
What is added by this report?
Racial and ethnic disparities in COVID-19 incidence among persons aged <25 years in
16 U.S. jurisdictions evolved during the pandemic. Disparities were substantial during
January–April and generally decreased during May–December, largely because of a greater
increase in incidence among White persons, rather than a decline among racial and
ethnic minority groups. The largest persistent disparities involved Native Hawaiian
and Pacific Islander, American Indian or Alaska Native, and Hispanic persons.
What are the implications for public health practice?
Ensuring equitable and timely access to preventive measures, including testing, safe
work and education settings, and vaccination when eligible is important to address
racial/ethnic disparities.