Working Paper Series
Intersectional inequities in COVID-19 mortality by race/ethnicity and
education in the United States, January 1, 2020–January 31, 2021
J. T. Chen,
ScD
1
, C. Testa, BS
2
,
P. Waterman, MPH
3
, N. Krieger, PhD
4
February 23, 2021
HCPDS Working Paper Volume 21, Number 3
The views expressed in this paper are those of the author(s) and do not necessarily reflect those of
the Harvard Center for Population and Development Studies.
Affiliations
1. Jarvis T. Chen, Lecturer on Social and Behavioral Sciences, Department of Social and Behavioral
Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
email: jarvis@hsph.harvard.edu
2. Christian Testa, Statistical Data Analyst, Department of Social and Behavioral Sciences, Harvard
T.H. Chan School of Public Health, Boston, MA
email: ctesta@hsph.harvard.edu
3. Pamela D. Waterman, Project Director, Department of Social and Behavioral Sciences, Harvard T.H.
Chan School of Public Health, Boston, MA
email: pwaterma@hsph.harvard.edu
4. Nancy Krieger, Professor of Social Epidemiology and American Cancer Society, Clinical Research
Professor, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public
Health, 677 Huntington Avenue, Boston, MA 02115
email: nkrieger@hsph.harvard.edu
Corresponding Author
Jarvis T. Chen, ScD
Lecturer on Social and Behavioral Sciences, Department of Social and Behavioral Sciences,
Harvard T.H. Chan School of Public Health
677 Huntington Avenue, Boston, MA 02115
Email: jarvis@hsph.harvard.edu
COI: None of the authors has any conflict of interest and no external funding supported this work.
IRB: This research is exempt from IRB review (no human subjects)
Word Count: 2,430
References: 22
Figures: 2
Tables: 3
Submitted: February 22, 2021
Abstract
Background: Although educational attainment is a routinely reported data element on US death
certificates, data on COVID-19 deaths were not reported by educational level, let alone stratified by
race/ethnicity and education, in government health statistics during the first year of the pandemic under
the Trump administration. On February 2, 2021, the US National Center for Health Statistics published a
national-level data table of COVID-19 deaths stratified by race/ethnicity and education, newly enabling
intersectional analysis of inequities in relation to racialized and educational groups.
Methods: We analyzed all COVID-19 deaths recorded for January 1, 2020 through January 31, 2021
(N = 413,196) in relation to individual-level death certificate data on race/ethnicity and educational level,
and corresponding US population data. We calculated rates per 100,000 person-years and associated 95%
confidence limits, and estimated incidence rate ratios (IRR) using saturated Poisson loglinear models.
Following STROBE guidelines for the presentation of interactions, we computed IRRs for (a)
racial/ethnic inequities within educational groups; (b) educational inequities within racial/ethnic groups;
and (c) intersectional inequities relative to a common reference group (Non-Hispanic Whites with a
postgraduate degree).
Results: First, regarding racialized inequities in COVID-19 mortality, crude rates were significantly
greater among Non-Hispanic Blacks (IRR 1.3, 95% CI 1.3, 1.3), Hispanics (IRR 1.1, 95% CI 1.1, 1.1),
and Non-Hispanic American Indian or Alaskan Natives (IRR 1.7, 95% CI 1.7, 1.7) and lower among
Non-Hispanic Asian Pacific Islanders (IRR 0.6, 95% CI 0.6, 0.6) compared with Non-Hispanic Whites.
Second, substantially elevated rates occurred for persons with less than a high school education (IRR 5.3,
95% CI 5.3, 5.3), high school graduates (IRR 3.4, 95% CI 3.4, 3.4), and some college (IRR 1.3, 95% CI
1.3, 1.3) relative to those with a postgraduate degree; rates among college graduates were virtually
identical to those with a postgraduate degree. Analysis of joint inequities by race/ethnicity and education
relative to a common reference group (Non-Hispanic Whites with a postgraduate degree, the theoretically
most advantaged group) showed that inequities in mortality are dominated by the steep educational
gradient in all groups, with those in the less than high school group having rate ratios ranging from 3.3
(Non-Hispanic Asian Pacific Islanders) to 7.8 (Non-Hispanic American Indian and Alaskan Natives)
relative to the reference group and those in the high school graduate group having rate ratios ranging from
2.1 (Hispanics and Non-Hispanic Asian Pacific Islanders) to 3.5 (Non-Hispanic Whites and Non-Hispanic
American Indian or Alaskan Natives). We found strong statistical evidence of interaction between
race/ethnicity and educational attainment on both the additive and multiplicative scales.
Conclusions: The release of these long overdue data on COVID-19 mortality rates by race/ethnicity and
educational attainment provide valuable insight into who has borne the unequal burden of COVID-19
death in the United States. Timely reporting of COVID-19 outcomes by race/ethnicity, socioeconomic
measures including education and occupation, age, and gender must be a priority to ensure transparency
and accountability and to support action to reduce the continuing impact of the pandemic on those most
adversely impacted by structural injustice.
Chen JT, Testa C, Waterman P, Krieger N. Intersectional inequities in COVID-19 mortality by race/ethnicity
and education in the United States, January 1, 2020 — January 31, 2021. Harvard Center for Population and
Development Studies Working Paper Volume 21, Number 3, February 23, 2021.
Page 1
Introduction
Calls to improve the reporting of race/ethnicity in data on deaths due to COVID-19 in
2020 [1] have contributed to a greater appreciation of the inequitably greater mortality burden
experienced by US populations of color, with Non-Hispanic Black, Hispanic, and Non-Hispanic
American Indian and Alaskan Native populations experiencing substantially elevated mortality
risk relative to their Non-Hispanic White and Non-Hispanic Asian Pacific Islander counterparts
[2]. However, simply reporting inequities by racialized group alone does little to explain why
these inequities exist or to how they can be reduced or eliminated. For example, although
educational attainment is a routinely reported data element on US death certificates [3, 4], data
on COVID-19 deaths were not reported by educational level, let alone stratified by race/ethnicity
and education, in government health statistics during the first year of the pandemic under the
Trump administration.
On February 2, 2021, the US National Center for Health Statistics published a national-
level data table of COVID-19 deaths stratified by race/ethnicity and education [5], signaling
what is hopefully a renewed commitment to data transparency and accountability under the
newly elected Biden-Harris administration. These data permit the first analysis of COVID-19
mortality inequities jointly by race/ethnicity and individual level socioeconomic position. In this
paper, we report on an intersectional analysis of these data and discuss implications for
understanding the drivers of inequities in COVID-19 deaths in the US.
Methods
Data Sources
We obtained cumulative provisional counts of death for COVID-19 (ICD-10 code U07.1
as an underlying or multiple cause of death) for the period January 1, 2020 through January 31,
Chen JT, Testa C, Waterman P, Krieger N. Intersectional inequities in COVID-19 mortality by race/ethnicity
and education in the United States, January 1, 2020 — January 31, 2021. Harvard Center for Population and
Development Studies Working Paper Volume 21, Number 3, February 23, 2021.
Page 2
2021 (N=413,196) from the US National Center for Health Statistics [5]. We excluded 10,810
deaths with unknown education and 1,682 with unknown race, accounting for 2.6% and 0.4% of
the total reported COVID-19 deaths respectively.
For analysis, we used the CDC categories for race/ethnicity, provided as: Non-Hispanic
White (NHW), Non-Hispanic Black (NHB), Hispanic (H), Non-Hispanic Asian Pacific Islander
(NHAPI), Non-Hispanic American Indian and Alaskan Native (NHAIAN), and Non-Hispanic
More Than One Race (NHMTOR) [5]. Due to small numbers, we report rates for NHMTOR in
Table 1 but do not present them in the figures. We categorized levels of educational attainment
as less than high school (combining 8
th
grade or less and 9-12 grade with no diploma), high
school graduate (high school graduate or GED-completed), some college (combining some
college credit but no degree and associate’s degree), college graduate (Bachelor’s degree), or
postgraduate degree (combining master’s degree and doctorate or professional degree).
We obtained estimates of population counts by educational attainment for those 18 years
and over in 2020 by race and Hispanic origin from the Annual Social and Economic supplement
of the US Census Bureau’s Current Population Survey [6]. Although the COVID-19 death data
include deaths of all ages, the number of COVID-19 deaths among individuals 0-17 years old is
very small (191 out of 443,107 total COVID-19 deaths (0.04%) as of February 6, 2021) [7] and
so we consider error introduced by the age mismatch to be negligible if we interpret computed
rates as applicable to the population 18 years and older. We treat these population counts as
representative of a year of person-time under observation, given that the first recorded COVID-
19 deaths in the US occurred in early February.
Chen JT, Testa C, Waterman P, Krieger N. Intersectional inequities in COVID-19 mortality by race/ethnicity
and education in the United States, January 1, 2020 — January 31, 2021. Harvard Center for Population and
Development Studies Working Paper Volume 21, Number 3, February 23, 2021.
Page 3
Statistical Analysis
We calculated rates per 100,000 person-years and associated 95% confidence limits using
standard formulae [8] and present these in Table 1. To estimate incidence rate ratios (IRR), we fit
saturated Poisson loglinear models for the count of COVID-19 deaths by race/ethnicity,
education, and the interaction of race/ethnicity and education, with log(population) as an offset.
Following STROBE guidelines for the presentation of interactions [9], we present incidence rate
ratios (IRR) in Table 2 for (a) racial/ethnic inequities within educational groups; (b) educational
inequities within racial/ethnic groups; and (c) intersectional inequities relative to a common
reference group (Non-Hispanic Whites with a postgraduate degree). Note that, because of the
large case numbers in this surveillance dataset, confidence limits for IRRs are extremely narrow.
To describe the intersectional effects [10] of the categories for racialized groups and
education on COVID-19 mortality (Table 3), we characterize the interaction of race/ethnicity and
education relative to Non-Hispanic Whites with a postgraduate degree (the theoretically most
advantaged group) on the multiplicative and additive scales. For the multiplicative scale, we
interpret the interaction terms from the Poisson model. To characterize interaction on the
additive scale, we calculate the relative excess risk due to interaction (RERI) based on
exponentiated regression coefficients from the Poisson model and obtain standard errors via the
delta method [11]. For comparisons where the reference racial/ethnic contrast is protective
among those with a postgraduate degree (i.e. among Hispanics and Non-Hispanic Asian Pacific
Islanders), we follow recommended practice and recode Non-Hispanics Whites to be “exposed”
for these comparisons [12].
Chen JT, Testa C, Waterman P, Krieger N. Intersectional inequities in COVID-19 mortality by race/ethnicity
and education in the United States, January 1, 2020 — January 31, 2021. Harvard Center for Population and
Development Studies Working Paper Volume 21, Number 3, February 23, 2021.
Page 4
Results
Figure 1a shows the distribution of educational attainment by race/ethnicity for adults age
18 and over in 2020. Compared to Non-Hispanic Whites, Non-Hispanic Blacks, Hispanics, and
Non-Hispanic American Indian or Alaskan Natives were disproportionately represented in lower
education categories, while Non-Hispanic Asian Pacific Islanders were more likely to be college
graduates or to hold a postgraduate degree (chi-squared p-value<0.001).
Figure 1b presents crude COVID-19 mortality rates by race/ethnicity (aggregating over
education groups). Crude rates were significantly greater among Non-Hispanic Blacks (IRR 1.3,
95% CI 1.3, 1.3), Hispanics (IRR 1.1, 95% CI 1.1, 1.1), and Non-Hispanic American Indian or
Alaskan Natives (IRR 1.7, 95% CI 1.7, 1.7) and lower among Non-Hispanic Asian Pacific
Islanders (IRR 0.6, 95% CI 0.6, 0.6) compared with Non-Hispanic Whites.
Figure 1c shows a strong inverse gradient in COVID-19 mortality rates by educational
attainment, with substantially elevated rates observed for those with less than a high school
education (IRR 5.3, 95% CI 5.3, 5.3), high school graduates (IRR 3.4, 95% CI 3.4, 3.4), and
some college (IRR 1.3, 95% CI 1.3, 1.3) relative to those with a postgraduate degree. Rates
among college graduates were virtually identical to those with a postgraduate degree.
Figure 1d stratifies simultaneously by race/ethnicity and educational attainment and
shows variation in the steepness of the educational gradient within racial/ethnic group as well as
pronounced differences in the racial/ethnic inequities within educational group. In particular,
while the highest rates in all racial/ethnic groups were observed among those with less than a
high school education, rates among high school graduates were similarly elevated among Non-
Hispanic Whites, Non-Hispanic Blacks, and Non-Hispanic American Indian or Alaskan Natives,
compared with Hispanics and Non-Hispanic Asian Pacific Islander. Meanwhile, COVID-19
Chen JT, Testa C, Waterman P, Krieger N. Intersectional inequities in COVID-19 mortality by race/ethnicity
and education in the United States, January 1, 2020 — January 31, 2021. Harvard Center for Population and
Development Studies Working Paper Volume 21, Number 3, February 23, 2021.
Page 5
mortality rates were relatively similar among Non-Hispanic Whites, Non-Hispanic Blacks, and
Hispanics in the most educated groups, while some differentiation between rates in these groups
was seen for Non-Hispanic American Indian or Alaskan Natives (whose rates were higher in
each education category relative to Non-Hispanic Whites) and Non-Hispanic Asian Pacific
Islanders (for whom the rate among those with a postgraduate degree was substantially lower).
These contrasts are further visualized in Figure 2, which presents (a) racial/ethnic rate
ratios within educational group, (b) educational rate ratios within racial/ethnic group, and (c) an
intersectional comparison relative to rates observed among Non-Hispanic Whites in the most
educated group. Corresponding IRRs and 95% Cis are presented in Table 2. Figure 2a highlights
effect measure modification of racial/ethnic inequities across educational categories: Non-
Hispanic Black rates were not appreciably different from Non-Hispanic White rates in the lowest
education categories, whereas a moderately increased risk of COVID-19 death for Non-Hispanic
Blacks emerges for those with some college education or higher (IRR=1.3, 95% CI 1.2, 1.3)
compared to Non-Hispanic Whites in the same educational category (summarized in Table 2). In
contrast, significantly elevated rates are seen among Non-Hispanic American Indian or Alaskan
Natives relative to Non-Hispanic Whites in all educational groups with the exception of high
school graduates, with the magnitude of the disparity varying from 1.3 to 2.0. Meanwhile,
though Hispanics were observed to have higher crude mortality rates relative to Non-Hispanic
Whites (Figure 1b), within strata of educational attainment, Hispanics have substantially
decreased mortality rates, as do Non-Hispanic Asian Pacific Islanders.
As shown in Figure 2b, a strong educational gradient in COVID-19 mortality rates is
observed in every racial/ethnic group, with the most extreme mortality rates observed for those
with less than a high school diploma and high school graduates. The steepness of the gradient
Chen JT, Testa C, Waterman P, Krieger N. Intersectional inequities in COVID-19 mortality by race/ethnicity
and education in the United States, January 1, 2020 — January 31, 2021. Harvard Center for Population and
Development Studies Working Paper Volume 21, Number 3, February 23, 2021.
Page 6
varies, with a markedly steeper gradient observed among Non-Hispanic Asian Pacific Islanders
due to their substantially lower rates among postgraduates.
Visualization of the joint inequities by race/ethnicity and education relative to a common
reference group (here, Non-Hispanic Whites with a postgraduate degree, the theoretically most
advantaged group) shows that inequities in mortality are dominated by the steep educational
gradient in all groups, with those in the less than high school group having rate ratios ranging
from 3.3 (Non-Hispanic Asian Pacific Islanders) to 7.8 (Non-Hispanic American Indian and
Alaskan Natives) relative to the reference group and those in the high school graduate group
having rate ratios ranging from 2.1 (Hispanics and Non-Hispanic Asian Pacific Islanders) to 3.5
(Non-Hispanic Whites and Non-Hispanic American Indian or Alaskan Natives). Nevertheless,
there is also strong statistical evidence of interaction between racialized groups and educational
attainment on both the additive and multiplicative scales, as summarized in Table 3.
Discussion
The release of these long overdue data on COVID-19 mortality rates by race/ethnicity
and educational attainment provide valuable insight into who has borne the unequal burden of
COVID-19 death in the United States. In particular, the magnitude of the inequities in COVID-
19 mortality rates by education, both overall and within racial/ethnic groups, speaks to the excess
mortality burden tied to socioeconomic deprivation and occupational hazards among people in
all racial/ethnic groups, whereby risk of exposure to SARS-Cov-2 is greatest among those
working in public facing, essential jobs, documented to be predominantly low wage precarious
jobs with limited or no sick pay and disproportionately employing workers of color [13,14].
In contrast, the excess mortality risk experienced by Non-Hispanic American Indian or
Alaskan Natives across educational groups reflects the extent to which concentrated outbreaks in
Chen JT, Testa C, Waterman P, Krieger N. Intersectional inequities in COVID-19 mortality by race/ethnicity
and education in the United States, January 1, 2020 — January 31, 2021. Harvard Center for Population and
Development Studies Working Paper Volume 21, Number 3, February 23, 2021.
Page 7
this community, particularly in the summer of 2020, were particularly devastating. Given
potential misclassification of NHAIAN deaths on death certificates [15], the rates we calculated
may well be underestimates and, if misclassification is more common among lower education
groups, educational inequities may be understated.
It is interesting to note that within educational categories, Hispanic mortality rates were
consistently lower than rates among Non-Hispanic Whites. This suggests that the overall
increased mortality rates experienced by Hispanics is driven in large part by their over-
representation in more disadvantaged education groups. Similarly, for the non-Hispanic Black
population, their equivalent mortality rates to Non-Hispanic Whites in the two lowest
educational strata, and their only slightly elevated risk in the higher educational strata suggests
that it is the inequities in educational distribution that drive the overall higher crude rates among
the non-Hispanic Black vs non-Hispanic White populations.
While we found that education, by virtue of the excessively large mortality inequities
experienced by those with less than a high school education or who are high school graduates, is
a strong driver of observed racialized inequities, there is nevertheless strong statistical evidence
of interaction between racialized group and education in relation to COVID-19 mortality on both
multiplicative and additive scales for all racial/ethnic and educational groups. Thus, it is
insufficient to conceive of individual education as “explaining” racial/ethnic inequities as the
variation in contrasts across racial/ethnic groups show that socioeconomic inequities are
“racialized” and, conversely, that racial/ethnic inequities are exacerbated in more
socioeconomically privileged groups. This is not a new pattern, and once again points to how
analyzing health inequities requires a “both/and,” not “either/or,” approach to addressing
structural injustice involving inequitable race and class relations [14,16,17].
Chen JT, Testa C, Waterman P, Krieger N. Intersectional inequities in COVID-19 mortality by race/ethnicity
and education in the United States, January 1, 2020 — January 31, 2021. Harvard Center for Population and
Development Studies Working Paper Volume 21, Number 3, February 23, 2021.
Page 8
While these data provide insight into the social patterning of COVID-19 inequities, there
are several important limitations to note. Firstly, the accuracy of reported educational attainment
on death certificates has been observed to vary with age, with previous empirical research
suggesting that individuals who did not graduate from high school are sometimes misclassified
as having obtained a high school diploma, especially among persons aged 65 and older [4,18].
The net effect may be to deflate the mortality rate among those with less than a high school
diploma and to inflate it among high school graduates, which suggests that the differences we
detected between these two categories may be even greater than the data suggest. Secondly, we
note that more granular data by age were not available for this analysis. Since US people of color
tend to have a younger age distribution compared to the US non-Hispanic white population and
since we have also previously reported substantially increased racial/ethnic inequities in COVID-
19 mortality at younger ages [2], these analyses likely understate the extent of racial/ethnic
inequities that would be visible if age-adjustment were possible.
Additionally, the available data are national and represent a full year of aggregated death
records. Thus, we are unable to account for geographical differences in racial/ethnic or
educational inequities or for the fact that US populations of color in different parts of the country
may have experienced peak COVID-19 mortality rates at different points during the year [19].
Nor do our analyses take into account the overall excess mortality linked to the COVID-19
pandemic, including deaths not classified as COVID-19 due to inequities in access to COVID-19
testing, as well as deaths caused by not by infection, but nevertheless reflecting the impact of the
pandemic (e.g., cardiovascular mortality not linked to infection but to limited access to health
care) [20]. These data limitations point to the urgent need for timely and detailed data on
COVID-19 mortality and excess deaths by race/ethnicity, education, and geography over time.
Chen JT, Testa C, Waterman P, Krieger N. Intersectional inequities in COVID-19 mortality by race/ethnicity
and education in the United States, January 1, 2020 — January 31, 2021. Harvard Center for Population and
Development Studies Working Paper Volume 21, Number 3, February 23, 2021.
Page 9
In the context of the extremely high COVID-19 case and mortality rates observed in the
United States in 2020, it is unfortunately not surprising to see the persistence of racialized and
socioeconomic inequities and the devastating impact on poor communities and communities of
color. Given the lackluster federal response to the pandemic in 2020, including failure to enact
substantial coronavirus relief or workplace protections that would have enabled working families
to avoid putting themselves at risk through continued work during lockdowns [14], the unequal
burden of the pandemic is once again falling on those most subjected to racialized and economic
injustice. Issues with vaccine distribution and barriers to access threaten to further exacerbate
COVID inequities [21,22]. Timely reporting of COVID-19 outcomes by race/ethnicity,
socioeconomic measures including education and occupation, age, and gender must be a priority
to ensure transparency and accountability and to support action to reduce the continuing impact
of the pandemic on those most adversely impacted by structural injustice.
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Development Studies Working Paper Volume 21, Number 3, February 23, 2021.
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21. Johnson CK, Kastanasis A, Stafford K. Revealed: study exposes racial disparity as whites
vaccinated as higher rates than Black Americans. The Guardian, January 30, 2021.
https://www.theguardian.com/us-news/2021/jan/30/covid-vaccine-black-americans-white-racial-
gap ; accessed February 22, 2021.
22. Hanson M, Egbert A. Inoculation nation: limited COVID-19 vaccine data shows uneven
access by race. APM Research Lab, February 17, 2021.
https://www.apmresearchlab.org/covid/vaccines-by-race ; accessed February 22, 2021.
Chen JT, Testa C, Waterman P, Krieger N. Intersectional inequities in COVID-19 mortality by race/ethnicity
and education in the United States, January 1, 2020 — January 31, 2021. Harvard Center for Population and
Development Studies Working Paper Volume 21, Number 3, February 23, 2021.
Page 14
FIGURES
Figure 1: (a) Distribution of educational attainment by race/ethnicity in the United States (US)
(2020) and US COVID-19 mortality rate per 100,000 (b) by race/ethnicity, (c) by educational
attainment, and (d) by race/ethnicity and educational attainment, January 1, 2020 - January 30,
2021.
Figure 2: US COVID-19 mortality rate ratios (a) by race/ethnicity within education group, (b) by
education within racial/ethnic group, and (c) relative to Non-Hispanic whites with a postgraduate
degree (intersectional comparison), January 1, 2020 - January 30, 2021.
Figure 1: (a) Distribution of educational attainment by race/ethnicity in the United States (US) (2020) and US
COVID-19 mortality rate per 100,000 (b) by race/ethnicity, (c) by educational attainment, and (d) by race/ethnicity and
educational attainment, January 1, 2020 - January 30, 2021
0.00
0.25
0.50
0.75
1.00
Non−Hispanic White Non−Hispanic Black Hispanic Non−Hispanic American Indian
or Alaska Native
Non−Hispanic Asian
Pacific Islander
Race/Ethnicity
Population Fraction
Education Level Less than high school High school graduate Some college College graduate Postgraduate degree
(a) Education distribution by race/ethnicity
157
199
171
265
95
0
100
200
300
400
Non−Hispanic
White
Non−Hispanic
Black
Hispanic Non−Hispanic
American Indian
or Alaska Native
Non−Hispanic
Asian Pacific
Islander
Race/ethnicity
Rate per 100,000 person−years
(b) COVID−19 mortality rates per 100,000 by race/ethnicity
390
252
99
74
74
0
100
200
300
400
Less than
high school
High school
graduate
Some
college
College
graduate
Postgraduate
degree
Education
Rate per 100,000 person−years
(c) COVID−19 mortality rates per 100,000 by education
426
278
99
75
80
425
275
125
85
94
358
168
74
61
63
625
276
201
126
103
264
170
76
68
34
0
200
400
600
Non−Hispanic White Non−Hispanic Black Hispanic Non−Hispanic American Indian
or Alaska Native
Non−Hispanic Asian
Pacific Islander
Race/ethnicity
Rate per 100,000 person−years
Education Less than high school High school graduate Some college College graduate Postgraduate degree
(d) COVID−19 mortality rate per 100,000 person−years by race/ethnicity and education
Figure 2: US COVID-19 mortality rate ratios (a) by race/ethnicity within education group, (b) by education within
racial/ethnic group, and (c) relative to Non-Hispanic whites with a postgraduate degree (intersectional comparison),
January 1, 2020 - January 30, 2021
0.0
0.5
1.0
1.5
2.0
Less than high school High school graduate Some college College graduate Postgraduate degree
Education
Rate Ratio
Race/ethnicity Non−Hispanic White Non−Hispanic Black Hispanic Non−Hispanic American Indian or Alaska Native Non−Hispanic Asian Pacific Islander
(a) COVID−19 mortality: racial/ethnic rate ratios within education group
0
2
4
6
8
Non−Hispanic White Non−Hispanic Black Hispanic Non−Hispanic American Indian
or Alaska Native
Non−Hispanic Asian
Pacific Islander
Race/ethnicity
Rate Ratio
Education Less than high school High school graduate Some college College graduate Postgraduate degree
(b) COVID−19 mortality: Education rate ratios within racial/ethnic group
0
2
4
6
8
Non−Hispanic White Non−Hispanic Black Hispanic Non−Hispanic American Indian
or Alaska Native
Non−Hispanic Asian
Pacific Islander
Race/ethnicity
Rate Ratio
Education Less than high school High school graduate Some college College graduate Postgraduate degree
(c) COVID−19 mortality: Rate ratios relative to Non−Hispanic Whites with Postgraduate degree
(ref) (ref) (ref) (ref) (ref)
(ref) (ref) (ref) (ref) (ref)
(ref)
Table 1: COVID-19 deaths and population (age>18 years old) by race/ethnicity and education, United States,
January 1, 2020 – January 31, 2021.
Race/ethnicity
Education Level
Deaths
Population
Rate per
100,000
person-years
(95%
CI)
Non-Hispanic White
Less than high school
38,901
9,133,850
425.9
(421.7
, 430.1)
High school graduate
117,989
42,386,917
278.4
(276.8
, 280.0)
Some college
44,812
45,121,322
99.3
(98.4
, 100.2)
College graduate
29,030
38,951,487
74.5
(73.7
, 75.4)
Postgraduate degree
18,073
22,658,100
79.8
(78.6
, 80.9)
Non-Hispanic Black
Less than high school
13,876
3,266,618
424.8
(417.7
, 431.8)
High school graduate
27,922
10,153,475
275.0
(271.8
, 278.2)
Some college
11,306
9,046,789
125.0
(122.7
, 127.3)
College graduate
4,265
5,020,760
84.9
(82.4
, 87.5)
Postgraduate degree
2,505
2,653,225
94.4
(90.7
, 98.1)
Hispanic
Less than high school
36,848
10,289,390
358.1
(354.5
, 361.8)
High school graduate
22,267
13,278,610
167.7
(165.5
, 169.9)
Some college
7,864
10,603,696
74.2
(72.5
, 75.8)
College graduate
3,351
5,514,294
60.8
(58.7
, 62.8)
Postgraduate degree
1,443
2,307,930
62.5
(59.3
, 65.7)
Non-Hispanic
American Indian or
Alaska Native
Less than high school
1,368
218,814
625.2
(592.1
, 658.3)
High school graduate
1,671
606,139
275.7
(262.5
, 288.9)
Some college
1,212
602,276
201.2
(189.9
, 212.6)
College graduate
282
223,071
126.4
(111.7
, 141.2)
Postgraduate degree
102
98,802
103.2
(83.2
, 123.3)
Non-Hispanic Asian
Pacific Islander
Less than high school
3,668
1,389,342
264.0
(255.5
, 272.6)
High school graduate
4,718
2,768,312
170.4
(165.6
, 175.3)
Some college
2,217
2,917,205
76.0
(72.8
, 79.2)
College graduate
3,617
5,307,947
68.1
(65.9
, 70.4)
Postgraduate degree
1,318
3,901,258
33.8
(32.0
, 35.6)
Non-Hispanic More
Than One Race
Less than high school
212
330,245
64.2
(55.6
, 72.8)
High school graduate
478
1,006,035
47.5
(43.3
, 51.8)
Some college
304
1,280,062
23.7
(21.1
, 26.4)
College graduate
154
773,498
19.9
(16.8
, 23.1)
Postgraduate degree
100
307,642
32.5
(26.1
, 38.9)
Table 2: Summary of inequities in COVID-19 mortality by race/ethnicity and educational attainment, United States, January 1, 2020-January 31,
2021.
Educational
attainment
Race/ethnicity
Racial/ethnic rate ratios within
education group
Race/ethnicity
Educational attainment
Education rate ratios within
racial/ethnic groups
Rate ratios relative to Non-Hispanic
Whites with a postgraduate degree
IRR
(95% CI)
IRR
(95% CI)
IRR
(95% CI)
Less than high
school
Non-Hispanic White
1.0
(reference)
Non-Hispanic White
Less than high school
5.3
(5.2
, 5.4)
5.3
(5.2
, 5.4)
Non-Hispanic Black
1.0
(1.0
, 1.0)
High school graduate
3.5
(3.4
, 3.5)
3.5
(3.4
, 3.5)
Hispanic
0.8
(0.8
, 0.9)
Some college
1.2
(1.2
, 1.3)
1.2
(1.2
, 1.3)
Non-Hispanic American
Indian or Alaska Native
1.5
(1.4
, 1.5)
College graduate
0.9
(0.9
, 1.0)
0.9
(0.9
, 1.0)
Non-Hispanic Asian Pacific
Islander
0.6
(0.6
, 0.6)
Postgraduate degree
1.0
(reference)
1.0
(reference)
High school
graduate
Non-Hispanic White
1.0
(reference)
Non-Hispanic Black
Less than high school
4.5
(4.3
, 4.7)
5.3
(5.2
, 5.4)
Non-Hispanic Black
1.0
(1.0
, 1.0)
High school graduate
2.9
(2.8
, 3.0)
3.4
(3.4
, 3.5)
Hispanic
0.6
(0.6
, 0.6)
Some college
1.3
(1.3
, 1.4)
1.6
(1.5
, 1.6)
Non-Hispanic American
Indian or Alaska Native
1.0
(0.9
, 1.0)
College graduate
0.9
(0.9
, 0.9)
1.1
(1.0
, 1.1)
Non-Hispanic Asian Pacific
Islander
0.6
(0.6
, 0.6)
Postgraduate degree
1.0
(reference)
1.2
(1.1
, 1.2)
Some college
Non-Hispanic White
1.0
(reference)
Hispanic
Less than high school
5.7
(5.4
, 6.0)
4.5
(4.4
, 4.6)
Non-Hispanic Black
1.3
(1.2
, 1.3)
High school graduate
2.7
(2.5
, 2.8)
2.1
(2.1
, 2.1)
Hispanic
0.7
(0.7
, 0.8)
Some college
1.2
(1.1
, 1.3)
0.9
(0.9
, 1.0)
Non-Hispanic American
Indian or Alaska Native
2.0
(1.9
, 2.1)
College graduate
1.0
(0.9
, 1.0)
0.8
(0.7
, 0.8)
Non-Hispanic Asian Pacific
Islander
0.8
(0.7
, 0.8)
Postgraduate degree
1.0
(reference)
0.8
(0.7
, 0.8)
College
graduate
Non-Hispanic White
1.0
(reference)
Non-Hispanic
American Indian or
Alaska Native
Less than high school
6.1
(5.0
, 7.4)
7.8
(7.4
, 8.3)
Non-Hispanic Black
1.1
(1.1
, 1.2)
High school graduate
2.7
(2.2
, 3.3)
3.5
(3.3
, 3.6)
Hispanic
0.8
(0.8
, 0.8)
Some college
1.9
(1.6
, 2.4)
2.5
(2.4
, 2.7)
Non-Hispanic American
Indian or Alaska Native
1.7
(1.5
, 1.9)
College graduate
1.2
(1.0
, 1.5)
1.6
(1.4
, 1.8)
Non-Hispanic Asian Pacific
Islander
0.9
(0.9
, 0.9)
Postgraduate degree
1.0
(reference)
1.3
(1.1
, 1.6)
Postgraduate
degree
Non-Hispanic White
1.0
(reference)
Non-Hispanic Asian
Pacific Islander
Less than high school
7.8
(7.3
, 8.3)
3.3
(3.2
, 3.4)
Non-Hispanic Black
1.2
(1.1
, 1.2)
High school graduate
5.0
(4.7
, 5.4)
2.1
(2.1
, 2.2)
Hispanic
0.8
(0.7
, 0.8)
Some college
2.2
(2.1
, 2.4)
1.0
(0.9
, 1.0)
Non-Hispanic American
Indian or Alaska Native
1.3
(1.1
, 1.6)
College graduate
2.0
(1.9
, 2.1)
0.9
(0.8
, 0.9)
Non-Hispanic Asian Pacific
Islander
0.4
(0.4
, 0.4)
Postgraduate degree
1.0
(reference)
0.4
(0.4
, 0.4)
Table 3: Intersectional interaction analysis of inequities in COVID-19 mortality by race/ethnicity and education, United States, January 1, 2020 –
January 31, 2021.
Race/ethnicity
Educational
attainment
Multiplicative interaction
Additive interaction
exp(β)
(95% CI)
Sub vs.
supermultiplicative
RERI*
(95% CI)
Sub vs.
superadditive
Non-Hispanic
White
Less than high school
-
-
High school graduate
-
-
Some college
-
-
College graduate
-
-
Postgraduate degree
-
-
Non-Hispanic
Black
Less than high school
0.8
(0.8
, 0.9)
submultiplicative
-0.2
-(0.3
-, 0.1)
subadditive
High school graduate
0.8
(0.8
, 0.9)
submultiplicative
-0.2
-(0.3
-, 0.2)
subadditive
Some college
1.1
(1.0
, 1.1)
supermultiplicative
0.1
(0.1
, 0.2)
superadditive
College graduate
1.0
(0.9
, 1.0)
null
-0.1
-(0.1
, 0.0)
null
Postgraduate degree
-
-
Hispanic
†
Less than high school
0.9
(0.9
, 1.0)
submultiplicative
0.8
(0.7
, 0.9)
superadditive
High school graduate
1.3
(1.2
, 1.4)
supermultiplicative
1.5
(1.4
, 1.5)
superadditive
Some college
1.0
(1.0
, 1.1)
null
0.1
(0.1
, 0.2)
superadditive
College graduate
1.0
(0.9
, 1.0)
null
-0.1
-(0.1
, 0.0)
null
Postgraduate degree
-
-
Non-Hispanic
American Indian
or Alaska Native
Less than high school
1.1
(0.9
, 1.4)
null
2.2
(1.7
, 2.7)
superadditive
High school graduate
0.8
(0.6
, 0.9)
submultiplicative
-0.3
-(0.6
, 0.0)
subadditive
Some college
1.6
(1.3
, 1.9)
supermultiplicative
1.0
(0.7
, 1.3)
superadditive
College graduate
1.3
(1.0
, 1.7)
supermultiplicative
0.4
(0.0
, 0.7)
superadditive
Postgraduate degree
-
-
Non-Hispanic
Asian Pacific
Islander
†
Less than high school
0.7
(0.6
, 0.7)
submultiplicative
3.4
(3.1
, 3.7)
superadditive
High school graduate
0.7
(0.6
, 0.7)
submultiplicative
1.8
(1.7
, 2.0)
superadditive
Some college
0.6
(0.5
, 0.6)
submultiplicative
-0.7
-(0.8
-, 0.5)
subadditive
College graduate
0.5
(0.4
, 0.5)
submultiplicative
-1.2
-(1.3
-, 1.0)
subadditive
Postgraduate degree
-
-
*
RERI = Relative Excess Risk due to Interaction
†
Recoded for interaction analysis so that Non-Hispanic White is “exposed” and Hispanic or Non-Hispanic Asian Pacific Islander is the reference category for race/ethnicity.
