Immigrant mortality advantage in the United States during the first year of the COVID-19 pandemic

Objective: To investigate the mortality impact of the COVID-19 pandemic on US-born and foreign-born populations by race and Hispanic origin in the United States in 2020. Methods: Death records from the National Center for Health Statistics and population data from CDC WONDER were used to estimate (1) age-standardized all-cause and cause-specific mortality at ages 25+, 25–64, and 65+ in 2017–2019 and 2020 by nativity, race, Hispanic origin, and sex; (2) changes in mortality between these two periods; and (3) the cause-specific contributions to these changes. Results: Mortality increased in 2020 relative to 2017–2019 for all racial and Hispanic-origin groups. Adjusting for age, mortality increases were larger at ages 25+ among foreign-born males (390 deaths for 100,000 residents) and females (189) than among US-born males (223) and females (144). The large mortality rise among foreign-born Hispanic men (593) contributed to the narrowing of their mortality advantage relative to White men, from 426 to 134. An increase in mortality among both foreign-born and US-born Black males and females increased the Black–White mortality disparities by 318 for males and by 180 for females. Although COVID-19 mortality was the main driver of the increase among foreign-born residents, circulatory diseases and malignant neoplasms also contributed. Contribution: We show that the COVID-19 pandemic had a greater impact on foreign-born populations than on their US-born counterparts. These findings highlight the need to address the underlying inequalities and unique challenges faced by foreign-born populations.