Katelyn Jetelina

In the beginning of the pandemic, I wrote a lot of posts addressing and countering mis- and dis-information. I’ve largely stopped because I am, quite frankly, tired of fighting. As Winston Churchill said, “A lie goes around the world before the truth get its pants on.” We also need more proactive, rather than reactive, communication. But an email was sent this morning to 6 million Americans from the New York Times The Morning entitled COVID and Race. TL;DR: The email reported that death rate for White Americans has recently exceeded the rates for Black, Latino and Asian Americans. The disparities seem to have flipped.

This is misinformation. Here’s me trying to push the truth to get its pants on faster.

Kernel of truth
Misinformation always has a kernel of truth. The kernel of truth in this reporting is that if we plot COVID19 deaths over time by race/ethnicity, White Americans are dying more than Blacks and Hispanics. This started in mid-to-late January 2022. I pulled the graphs below from the CDC (notice the x-axis range is different).

The problem is that kernels of truth are then taken out of context and people come to inaccurate conclusions. Sometimes the context is removed purposefully (called disinformation) but most of the time it’s not purposeful (called misinformation).

Simpson’s Paradox
The context missing here is Simpson’s Paradox—“statistical phenomenon where an association between two variables in a population emerges, disappears or reverses when the population is divided into subpopulations.” In other words, if we just slap data on a graph, it looks like one very clear story. However, when we take into account confounders—or other variables that could also explain this phenomenon—it tells another story.

In this case, we need to take into account age. White Americans are far more likely to outlive Black or Hispanic Americans. They live longer for a whole myriad of reasons, like differences in access to care, trauma, stress, etc. This is important because age is the strongest risk factor, by far, for dying of COVID.

If we account for age, we see a very different story. Below is data from a database called CDC WONDER. The 2022 death data is provisional (which means it’s not the official count because death certificates take a long time to process), but it’s the best we have. I pulled all COVID deaths for 2022 and organized by race. Before adjusting for age, White Americans account for 43 per 100,000 deaths in 2022 compared to, for example, Black Americans, who account for 37 per 100,000 deaths. After we adjust for age, the story changes: Whites account for 31 per 100,000 deaths while Blacks account for 40 per 100,000. A complete switch.

If we look at this phenomenon over time, the gap is narrowing. Below I graphed the difference between crude and age-adjusted deaths over time by race/ethnicity. Public health departments and grassroots organizations have been working tirelessly to get vaccinations to underserved communities. And, deaths among White Americans have increased faster over the past 3 years. But the association has not flipped like the NYT article concluded. Unfortunately, outrunning decades-long health disparities that under-served communities face in this country is incredibly difficult.

Bottom line
There are really important, big public health questions we need answered. And bringing them to light and having discussions is more than important. But we need to answer them responsibly, because, as we’ve seen throughout the pandemic, misinformation can do serious damage to public health responses.

Love, YLE

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, biostatistician, wife, and mom of two little girls. During the day she works at a nonpartisan health policy think tank, and at night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well equipped to make evidence-based decisions. This newsletter is free thanks to the generous support of fellow YLE community members.