​Summary: The U.S.A. leads the world in the number of COVID-19 cases and deaths. However, COVID-19 has not impacted all communities equally. Prior reports have shown higher rates of COVID-19 cases and deaths in Black, Latinx, and American Indian/Alaska Native (AIAN) communities; data for Asians and Native Hawaiian Pacific Islander (NHPI) are aggregated or non-existent, leaving disparities within these communities of color unknown and, thus, invisible. Using a dataset that disaggregates and reports Asian and NHPI deaths by age, the authors evaluate the attributable COVID-19 mortality burden on Asians, NHPIs, and other racial/ethnic groups of color, in comparison to non-Hispanic Whites. Authors used data from the National Center for Health Statistics (NCHS), which provides weekly updated, national data on the count and distribution of COVID-19 deaths and total deaths by age and race/ethnicity. Data included COVID-19 deaths between February 1 and October 10, 2020.

Findings: The authors findings are consistent with others reporting the disproportionate burden of COVID-19 among Latinx and Black Americans, but the analysis raises concern about the lack of policy attention of the COVID-19 burden among Asians and NHPIs. Asians, Latinx, and Black Americans had the three highest COVID-19 attributable deaths, with frequencies at least twice that of Whites. Similar to many communities of color, Asians and NHPIs may have worse COVID-19 mortality because they disproportionately work in health care and other essential jobs, have underlying medical comorbidities, and are more likely to live in denser, multi-generational households. The higher attributable death among Asians may also be due to a heightened xenophobia that may have discouraged Asians from seeking timely testing and treatment, particularly among 60% of the population who are immigrants and 23% who are limited English proficient.

The authors’ analysis uncovering Asian and NHPI attributable COVID-19 deaths by age is significant as this disaggregated data is not available in many public datasets. The Office of Management and Budget requires that agencies receiving federal funding report Asians as a separate category from NHPIs, while some states continue to categorize Asians and NHPIs as one category, and others aggregate Asians, NHPIs, and AIANs under “Other.” Authors advocate correcting this. Over the course of this pandemic, public health departments must provide access to COVID-19 testing, case, death, hospitalization data by primary language, and disaggregated race/ethnicity. This would improve prevention, mitigate spread, and provide better health care for Asians and NHPIs whose lives and livelihoods have been overlooked and harmed by incomplete or missing data.