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Study: Racial disparities seen in U.S. children whose parent or caregiver died of COVID-19

November 1, 2021

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More than 140,000 U.S. children lost a parent or grandparent-caregiver during the pandemic, and the risk of loss was up to five times higher for children of racial and ethnic minorities compared with those of non-Hispanic Whites, according to a new study.

The study estimated the numbers of children ages 0 to 17 years whose mothers, fathers or co-resident grandparents died due to COVID-19 from April 2020 through June 2021. COVID-19-associated deaths of parents and caregivers were analyzed for Hispanic and non-Hispanic populations nationally and in every state.

COVID-associated orphanhood or death of a grandparent-caregiver impacted one in 168 American Indian/Alaska Native (AI/AN) children, one in 310 Black children, one in 412 Hispanic children and one in 753 White children.

The findings are reported in “COVID-19-Associated Orphanhood and Caregiver Death in the United States,” (Hillis SD, et al. Pediatrics. Oct. 7, 2021,

While at least 680,000 people in the U.S. have died of COVID-19, little attention has been placed on children who suffer the profound loss of a parent or caregiver. The study showed the “overlooked burden among children at greatest risk, in states most affected.”

Researchers used fertility rates, excess mortality and COVID-19 mortality, and household composition data to estimate numbers, rates and ratios for children impacted by COVID-associated “orphanhood” and deaths of caregivers.

Orphanhood was defined as death of one or both parents. Primary caregivers were defined as parents or grandparents responsible for most of a child’s needs and care, and secondary caregivers were grandparents providing some basic needs or care.

The study found:

  • White children account for about 35% of those who lost primary caregivers and represent 53% of the total population. Children of racial and ethnic minorities account for 65% of children who lost primary caregivers compared with 47% of the population. Hispanic and Black children account for 32% and 26%, respectively, of all children losing their primary caregiver, compared with 26% and 15% of the total population.
  • Of 142,637 children who experienced the death of a parent/caregiver, 120,630 lost a primary caregiver. About 91,256 children in racial/ethnic minority groups lost a primary caregiver, compared with 51,381 of non-Hispanic Whites.
  • Most of the parents and caregivers who died lived in Southeastern states for Black children, Southern border states for Hispanic children and states with tribal areas for AI/AN populations.
  • Along the U.S.-Mexico border, many children who lost primary caregivers were of Hispanic ethnicity (67% in California, 58% in Texas and 49% in New Mexico). Of children who lost caregivers in the Southeast, a large proportion were Black (57% in Mississippi, 54% in Louisiana and 45% in Alabama). AI/AN children were more often represented in South Dakota (55%), New Mexico (39%), Montana (38%), Oklahoma (23%) and Arizona (18%).

Impacts of disparities

The pandemic has magnified social and health disparities in disease occurrence, severity and outcomes among geographies and racial and ethnic groups, the authors noted. Contributing factors include structural and social determinants of health such as discrimination, neighborhood environment, barriers in access to health care, occupation, educational gaps, economic instability, living arrangements and unstable housing.

These factors increase exposure to SARS-CoV-2 infection among racial and ethnic minorities due to their disproportionate representation in essential jobs and greater likelihood of multigenerational living arrangements.

The disparities in numbers of children affected also might be influenced by variations in fertility, age at childbearing, comorbidities, access to health services, social vulnerability, longevity and rates of caregiving by grandparents.

Comprehensive response needed

The long-term effects on children who lose parents and caregivers can include mental health issues, shorter schooling, lower self-esteem, sexual risk behaviors, and risks of suicide, violence, sexual abuse and exploitation. After caregivers die and family circumstances change, children may grapple with housing instability, separations and lack of nurturing support.

Consequently, the authors conclude, there is an urgent need for a comprehensive response for those at greatest risk who need safe, stable and nurturing families with economic support, quality child care and parenting support programs. Response should include equitable access to vaccines and evidence-based programs for bereaved children, especially in areas with greatest disparities.



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