As the United States enters its third holiday season navigating a potential increase in COVID-19 cases as well as other respiratory illnesses, federal data from the Centers for Disease Control and Prevention (CDC) show that as of November 9, 2022, 80% of the total population in the United States have received at least one dose of a COVID-19 vaccine and only 10% of eligible individuals have received the updated, bivalent booster that was authorized for use among individuals 5 years of age and older in early Fall 2022. Individuals who have not received any booster dose are at higher risk of infection from the virus, and people who remain unvaccinated continue to be at particularly high risk for severe illness and death.
Over the course of the pandemic, racial disparities in cases and deaths have widened and narrowed. However, overall, Black, Hispanic, and American Indian and Alaska Native (AIAN) people have borne the heaviest health impacts of the pandemic, particularly when adjusting data to account for differences in age by race and ethnicity. While Black and Hispanic people were less likely than their White counterparts to receive a vaccine during the initial phases of the vaccination rollout, these disparities have narrowed over time and reversed for Hispanic people. Despite this progress, a vaccination gap persists for Black people. COVID-19 outpatient treatments, which can mitigate hospitalization and death from COVID-19, are also available. However, early data suggest racial disparities in access to and receipt of these treatments.
This data note presents an update on the status of COVID-19 cases and deaths, vaccinations, and treatments by race/ethnicity as of Fall 2022, based on federal data reported by the Centers for Disease Control and Prevention (CDC).
What is the status of COVID-19 cases and deaths by race/ethnicity?
Racial disparities in COVID-19 cases and deaths have widened and narrowed over the course of the pandemic, but when data are adjusted to account for differences in age by race/ethnicity, they show that AIAN, Black, and Hispanic people have had higher rates of infection and death than White people over most of the course of the pandemic. Early in the pandemic, there were large racial disparities in COVID-19 cases. Disparities narrowed when overall infection rates fell. However, during the surge associated with the Omicron variant in Winter 2022, disparities in cases once again widened with Hispanic (4,341 per 100,000), AIAN (3,818 per 100,000), Black (2,937 per 100,000), and Asian (2,755 per 100,000) people having higher age-adjusted infection rates than White people (2,693 per 100,000) as of January 2022 (Figure 1). Following that surge, infection rates fell in Spring 2022 and disparities have once again narrowed. However, as of September 2022, the age-adjusted COVID-19 infection rates were still highest for Black and Hispanic people (192 per 100,000 for each group), followed by AIAN people at 188 per 100,000. White and Asian people had the lowest infection rates at 164 per 100,000 and 153 per 100,000, respectively. While death rates for most groups of color were substantially higher compared with White people early on in the pandemic, since late Summer 2020, there have been some periods when death rates for White people have been higher than or similar to some groups of color. However, age-adjusted data show that AIAN, Black, and Hispanic people have had higher rates of death compared with White people over most of the pandemic and particularly during surges. For example, as of January 2022, amid the Omicron surge, age-adjusted death rates were higher for Black (37.4 per 100,000), AIAN (34.7 per 100,000), and Hispanic people (29.9 per 100,000) compared with White people (23.5 per 100,000) (Figure 1). Following that surge, disparities narrowed when death rates fell. As of August 2022, age-adjusted death rates were similar for AIAN (4.9 per 100,000), Black (4.4 per 100,000), and White people (4.2 per 100,000) and lower for Hispanic (3.6 per 100,000) and Asian (2.7 per 100,000) people. Despite these fluctuations over time, total cumulative age-adjusted data continue to show that Black, Hispanic, and AIAN people have been at higher risk for COVID-19 cases, hospitalizations, and deaths compared with White people.
What are COVID-19 vaccination and booster patterns by race/ethnicity?
While disparities in COVID-19 vaccinations have narrowed over time and have been reversed for Hispanic people, they persist for Black people. Ongoing KFF analysis shows that at both the federal and state level, there were large gaps in vaccination for Black and Hispanic people in the initial phases of the vaccination rollout, which narrowed over time and eventually reversed for Hispanic people. Despite this progress, a vaccination gap persists for Black people. According to the CDC, overall, 80% of people had received at least one COVID-19 vaccination dose as of November 9, 2022, and race/ethnicity was known for 75% of people who had received at least one dose. Based on those with known race/ethnicity, about half (50%) of Black people had received at least one dose compared with 56% of White people, two-thirds (66%) of Hispanic people, and over seven in ten Native Hawaiian and other Pacific Islander (NHOPI) (70%), Asian (72%), and AIAN (77%) people (Figure 2).
Overall, few people have received the updated bivalent booster vaccine dose, and Black and Hispanic people are about half as likely as White people to have received this booster so far. The updated bivalent boosters protect against both the original virus that causes COVID-19 and the BA.4 and BA.5 Omicron variants. These boosters became available for people ages 12 years and older on September 2, 2022, and for people ages 5-11 years old on October 12, 2022. The CDC recommends that people ages 5 years and older receive one bivalent booster at least 2 months after their last COVID-19 vaccine dose. The CDC reports that, overall, 10% of people over age five have received the updated bivalent booster vaccine dose as of November 9, 2022, with race/ethnicity data available for 88%. Based on those with known race/ethnicity, 11% of eligible Asian and 10% of eligible White people had received a bivalent booster dose, roughly twice the shares of eligible Black (5%) and Hispanic people (4%) (Figure 2). The bivalent booster dose rate was 6% for eligible NHOPI people and 8% for eligible AIAN people.
What are COVID-19 treatment patterns by race/ethnicity?
New data from CDC show racial disparities in receipt of COVID-19 oral antiviral treatments, including Paxlovid, the most widely prescribed antiviral. As of November 2022, there are four COVID-19 outpatient treatments, including: Paxlovid and Lagevrio, oral antivirals that were both approved in December 2021; Veklury, an IV infusion antiviral that was approved in January 2021; and Bebtelovimab a monoclonal antibody that was approved in February 2022. Outpatient COVID-19 treatments are recommended for people who have tested positive for COVID-19 with mild to moderate symptoms and who are at high risk of developing severe illness. Prior KFF analysis pointed to potential disparities in access to COVID-19 treatments for counties with the highest poverty rates and those that are majority Black, Hispanic, and AIAN. Other analyses have documented disparities in monoclonal antibody treatments by race and ethnicity as well as disparities in oral antiviral treatment by zip-code vulnerability. An October 2022 CDC Morbidity and Mortality Weekly Report adds to these findings showing that, through July 2022, people of color were less likely to receive currently available outpatient antiviral COVID-19 treatments compared with their White counterparts. Specifically, between April to July 2022, the percentage of COVID-19 patients aged 20 years and older treated with Paxlovid was lower among Black (21%) and Hispanic (21%) patients than among White (32%) and non-Hispanic (30%) patients, respectively (Figure 3). The shares of AIAN and NHOPI (25%) and Asian (26%) patients receiving prescriptions were also smaller compared to the share of White patients. These disparities were observed across all age groups and were more evident among adults ages 50 and older and immunocompromised patients. Racial and ethnic disparities existed for treatment with other medications, but differences were small given overall low levels of treatment with these other medications.
While disparities in cases and deaths have widened and narrowed over the course of the pandemic, age-adjusted data show that AIAN, Black, and Hispanic people have had higher rates of cases and death compared with White people over most of the course of the pandemic and that they have experienced overall higher rates of infection, hospitalization, and death.
Data point to significantly increased risks of COVID-19 illness and death for people who remain unvaccinated or have not received an updated bivalent booster dose. During the initial vaccine rollout, Black and Hispanic people were less likely to receive vaccines than their White counterparts. However, these disparities have narrowed over time and reversed for Hispanic people, though they persist for Black people. Despite this progress in initial vaccination uptake, overall uptake of the updated bivalent booster dose has been slow so far, and there have been racial disparities in receipt of these booster doses, with eligible Black, Hispanic, and NHOPI people about half has likely to have received an updated booster than their White counterparts. Data also point to disparities in receipt of COVID-19 treatments, with patients of color less likely to receive oral antivirals, including Paxlovid, compared to White patients.
Overall, these data show that although the pandemic has contributed to growing awareness and focus on addressing racial disparities, they persist, reflecting the underlying structural inequities that drive them. The findings highlight the importance of a continued focus on equity and efforts to address inequities that leave people of color at increased risk for exposure, illness, and death as well as to close gaps in access to health care, including COVID-19 treatments. Addressing these gaps is of increasing importance as these disparities may be exacerbated when federal funding for COVID-19 vaccines, treatments, and tests runs out and some people may face increased out-of-pocket costs to access these services. Addressing these inequities is key for narrowing the disparate effects of COVID-19 going forward as well as for preventing similar disparities associated with future public health threats.