Geographic Variation in Racial Disparities in Mortality from Influenza and Pneumonia in the US in the Pre-COVID-19 Era.

Abstract Background In 2018, influenza and pneumonia was the 8th leading cause of death in the United States (US). Since 1950, non-Hispanic blacks (NHB) have experienced higher rates of mortality than non-Hispanic whites (NHW). Previous studies revealed geographic variation in mortality rates by race. The identification of areas with the greatest disparity in influenza and pneumonia mortality may assist policy makers in the allocation of resources including for the COVID-19 pandemic. Research Question Does geographic variation in racial disparity in influenza and pneumonia mortality exist? Study Design and Methods: The Centers for Disease Control and Prevention (CDC) database for multiple cause of death between 1999-2018 for NHB and NHW decedents aged ≥ 25 years with an ICD-10 code for influenza (J09-J11) and pneumonia (J12-J18) was used. Age-adjusted mortality rates (AAMR) with 95% confidence intervals (CI)were computed by race for Health & Human Services (HHS) regions and urbanization in non-Hispanics Results In 1999-2018, there were 540,476 deaths among NHB and NHW aged 25-84 years. AAMR was higher in NHB than NHW in each age group and in 7 of 10 HHS regions. The greatest disparity was in HHS regions 2 (NY, NJ) and 9 (Arizona, California, Hawaii, Nevada). In HHS region 2, NHB [24.6 (95% CI 24.1-25.1)] were more likely to die than NHW [15.7 (95% CI 15.6-15.9)]. Similarly, in region 9, NHB [23.2 (95% CI 22.7-23.8)] had higher mortality than NHW [16.1 (95% CI 15.9-16.2)]. Within these regions, disparities were greatest in the core of major metropolitan areas. Much of the disparity was due to very high mortality rates in NHB in these areas: region 2 large central metro areas NHB 28.2 (95% CI 27.6-28.9). Interpretation In 1999-2018 the NHB-NHW disparity in AAMR from influenza and pneumonia was greatest in central metro areas of HHS regions 2 and 9.