Over the early twentieth century, urban centers adopted full-time public health departments. We show that opening full-time administration had little observable impact on mortality. We then attempt to determine why health departments were ineffective. Our results suggest that achievements in public health occurred regardless of health department status. Further, we find that cities with and without a full-time health department allocated similar per capita expenditures towards health administration. This health department funding also better predicts infant mortality declines. Our conclusions indicate that specific campaigns, public health systems, and funding may have been more meaningful for local health over this era.

The authors provide the first age-standardized race/ethnicity-specific, state-specific vaccination rates for the United States. Data encompass all states reporting race/ethnicity-specific vaccinations and reflect vaccinations through mid-October 2021, just before eligibility expanded below age 12. Using indirect age standardization, the authors compare racial/ethnic state vaccination rates with national rates. The results show that white and Black state median vaccination rates are, respectively, 89 percent and 76 percent of what would be predicted on the basis of age; Hispanic and Native rates are almost identical to what would be predicted; and Asian American/Pacific Islander rates are 110 percent of what would be predicted. The authors also find that racial/ethnic vaccination rates are associated with state politics, as proxied by 2020 Trump vote share: for each percentage point increase in Trump vote share, vaccination rates decline by 1.08 percent of what would be predicted on the basis of age. This decline is sharpest for Native American vaccinations, although these are reported for relatively few states.

Recent research underscores the exceptionally young age distribution of Covid-19 deaths in the United States compared with international peers. We show that the high level of Covid mortality at midlife ages (45-64) is deeply intertwined with continuing racial inequality in Covid-19 mortality, which persists even in contexts in which non-white populations might seem to have a survival advantage. We use data from Minnesota, which allows vaccination and mortality rates to be observed with greater age and temporal precision than national data. At midlife ages in Minnesota, Black, Hispanic, and Asian populations were all more highly vaccinated than white populations during the state’s substantial and sustained Delta surge. Yet white mortality rates were lower than those of all other racial groups. These mortality disparities were extreme; during the Delta period, non-white Covid-19 mortality at ages 55-64 was greater than white mortality at 10 years older. This discrepancy between vaccination and mortality patterning by race suggests that, if the current period is a “pandemic of the unvaccinated,” it also remains a “pandemic of the disadvantaged” in ways that can decouple from vaccination rates. This result implies an urgent need to center health equity in the development of Covid-19 policy measures. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research was funded by the Eunice Kennedy Shriver National Institute on Child Health and Human Development (P2CHD041023, F31HD107980), the National Institute on Aging (P30AG066613, R01AG060115-04S1), the Robert Wood Johnson Foundation (Grant #77521), and the University of Minnesota School of Public Health. The interpretations, conclusions, and recommendations in this work are those of the authors and do not necessarily represent the views of the National Institutes of Health or the Robert Wood Johnson Foundation. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of the University of Minnesota waived ethical approval for this work. The University of Minnesota IRB's study identifier for this study's exemption from full review is STUDY00012527. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced are available online at <https://osf.io/bxjkh/?view_only=80e912ce2b624ab7a78e51754c3952e3> <https://osf.io/bxjkh/?view_only=80e912ce2b624ab7a78e51754c3952e3>

This research brief provides one of the first examinations of the impact of COVID-19 mortality on immigrant communities in the United States. In the absence of national data, we examine COVID-19 deaths in Minnesota, historically one of the major U.S. refugee destinations, using individual-level death certificates obtained from the Minnesota Department of Health Office of Vital Records. Minnesota’s foreign-born crude COVID-19 death rates were similar to rates for the US-born, but COVID-19 death rates adjusted for age and gender were twice as high among the foreign-born. Among foreign-born Latinos, in particular, COVID-19 mortality was concentrated in relatively younger, prime working age men. Moreover, the place-based and temporal patterns of COVID-19 mortality were quite distinct, with the majority of US-born mortality concentrated in long-term care facilities and late in 2020, and foreign-born mortality occurring outside of residential institutions and earlier in the pandemic. The disparate impacts of COVID-19 for foreign-born Minnesotans demonstrate the need for targeted public health planning and intervention in immigrant communities.

COVID-19 mortality increases dramatically with age and is also substantially higher among Black, Indigenous, and People of Color (BIPOC) populations in the United States. These two facts introduce tradeoffs because BIPOC populations are younger than white populations. In analyses of California and Minnesota--demographically divergent states--we show that COVID vaccination schedules based solely on age benefit the older white populations at the expense of younger BIPOC populations with higher risk of death from COVID-19. We find that strategies that prioritize high-risk geographic areas for vaccination at all ages better target mortality risk than age-based strategies alone, although they do not always perform as well as direct prioritization of high-risk racial/ethnic groups. One-sentence summary Age-based COVID-19 vaccination prioritizes white people above higher-risk others; geographic prioritization improves equity.

Substantial racial and ethnic disparities in COVID-19 mortality have been observed at the state and national levels. However, less is known about how race and ethnicity and neighborhood-level disad...

The COVID-19 pandemic is causing a catastrophic increase in US mortality. How does the scale of this pandemic compare to another US catastrophe: racial inequality? Using demographic models, I estimate how many excess White deaths would raise US White mortality to the best-ever (lowest) US Black level under alternative, plausible assumptions about the age patterning of excess mortality in 2020. I find that 400,000 excess White deaths would be needed to equal the best mortality ever recorded among Blacks. For White mortality in 2020 to reach levels that Blacks experience outside of pandemics, current COVID-19 mortality levels would need to increase by a factor of nearly 6. Moreover, White life expectancy in 2020 will remain higher than Black life expectancy has ever been unless nearly 700,000 excess White deaths occur. Even amid COVID-19, US White mortality is likely to be less than what US Blacks have experienced every year. I argue that, if Black disadvantage operates every year on the scale of Whites’ experience of COVID-19, then so too should the tools we deploy to fight it. Our imagination should not be limited by how accustomed the United States is to profound racial inequality.

<p>How much life in the United States is lost to encounters with the police? The author builds on a demographic life table model by Edwards, Lee, and Esposito to estimate, for race- and gender-specific populations, how many years of life are lost in two categories of police encounters: (1) encounters involving officer use of force and (2) all deaths involving police encounters. Average life years lost by individuals who are killed ranges from 39 years (white men) to 52 years (Native women). The loss of years per 100,000 people over their collective lifetimes is largest for Black men, with 5,696 years of life lost to all encounters with police, of which 3,772 years are lost to police use of force. This implies a loss of roughly 16,000 years of life for recent cohorts of Black men. These results provide context for current debates surrounding the cost and necessity of protests.</p>

The mortality rate of non-Hispanic white Americans in midlife has been rising since the beginning of the 21st century, in contrast to the national decline in deaths from infectious disease witnessed during the previous century. This column reviews the fall in infectious mortality in US cities across regions and racial groups. It finds that southern cities had the highest rate of death from infectious disease in every year from 1900 to 1948, primarily because southern cities were populated by greater proportions of black residents, who suffered extreme risks from infectious disease in cities in all regions.

In the first half of the twentieth century, the rate of death from infectious disease in the United States fell precipitously. Although this decline is well-known and well-documented, there is surprisingly little evidence about whether it took place uniformly across the regions of the U.S. We use data on infectious disease deaths from all reporting U.S. cities to describe regional patterns in the decline of urban infectious mortality from 1900 to 1948. We report three main results: First, urban infectious mortality was higher in the South in every year from 1900 to 1948. Second, the timing of the infectious mortality decline was different in southern cities than in cities in the other regions. Third, comparatively high infectious mortality in southern cities was driven overwhelmingly by extremely high infectious mortality among African Americans. From 1906 to 1920, African Americans in cities experienced a rate of death from infectious disease greater than what urban whites experienced during the 1918 flu pandemic.

BACKGROUND

BACKGROUND

The 1918 influenza pandemic stands out for its extreme virulence and unusual age pattern of mortality. Here, we aim to elevate a third unusual feature of its course through United States cities to the same level of scientific prominence: the pandemic produced strikingly small racial disparities in mortality, against a backdrop of extreme racial inequality in the era. We provide the most complete account of racial disparities in influenza and pneumonia mortality in U.S. cities in 1918, showing that they were almost uniformly small. We also advance and evaluate four hypotheses as to why racial disparities in the 1918-1919 pandemic were so small relative to those in proximate years. In particular, we assess hypotheses related to socio-demographic characteristics like segregation, city-level implementation of non-pharmaceutical interventions, racial differences in exposure to the 1918 herald wave, and racial differences in early-life exposures to other influenza strains that could have resulted in differences in immunological vulnerability to the 1918 flu. The results suggest the importance of considering in depth the interactions between the natural history of a particular microbial agent and the social history of the populations it infects.

What is the average lifespan in a stationary population viewed at a single moment in time? Even though periods and cohorts are identical in a stationary population, we show that the answer is not life expectancy, but a length-biased version of life expectancy. That is, the distribution of lifespans of the people alive at a single moment is a self-weighted distribution of cohort lifespans, such that longer lifespans have proportionally greater representation. This result connects stationary population lifespan measures to a well-developed body of statistical results; provides new intuition for established demographic results; generates new insights into the relationship between periods, cohorts, and prevalent cohorts; and offers a framework for thinking about mortality selection more broadly than the concept of demographic frailty. Acknowledgements: