The number of excess deaths among patients with end-stage kidney disease (ESKD) in the United States during the COVID-19 pandemic from March 1 to August 1, 2020 was substantially higher among Black and Hispanic patients compared with White patients, according to a recent analysis.1

During that period, the number of excess deaths — defined as the difference between observed and expected deaths based on historical trends — was 16%, with 72% of all excess deaths occurring among Black and Hispanic patients, Daeho Kim, PhD, of Brown University in Providence, Rhode Island, and colleagues reported in the American Journal of Kidney Diseases. The relative increase in deaths among Black and Hispanic patients was more than 4-fold higher than that observed among White patients. “The magnitude of these disparities was larger than the relative ratios reported among COVID-19-associated deaths in the general population,” the authors wrote.

For example, Dr Kim and colleagues cited a 2020 study published in the Journal of General Internal Medicine showing that the relative ratios of COVID-19-associated deaths were 3.6 for Black and 1.9 for Hispanic people relative to White people.2

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“Our findings on the racial and ethnic disparities in excess deaths are likely explained by inequities in the social determinants of health,” Dr Kim’s team noted. “These determinants include income, living conditions, access to health care, and structural racism, the historical and contemporary social structures that systematically disadvantage racial/ethnic minorities.”

The Centers for Medicare and Medicaid Services death notification form the investigators used to obtain data on deaths of patients with ESKD does not list COVID-19 as a separate cause of death, so the study outcome was all-cause mortality.


  1. Kim D, Lee Y, Thorsness R, et al. Racial and ethnic disparities in excess deaths among persons with kidney failure during the COVID-19 pandemic, March-July 2020. Published online February 10, 2021. Am J Kidney Dis. doi:10.1053/j.ajkd.2021.02.003
  2. Gross CP, Essien UR, Pasha S, Gross JR, Wang SY, Nunez-Smith M. Racial and ethnic disparities in population-level COVID-19 mortality. J Gen Intern Med. 2020;35:3097-3099. doi:10.1007/s11606-020-06081-w