The death rate for Massachusetts residents rose 6% in 2021, compared to the most recent pre-pandemic year, 2019. That’s according to an analysis of the latest state-level data from the Centers for Disease Control and Prevention, which was released in January.

That increase in deaths was largely because of COVID-19, which killed nearly 5,000 people in the state in 2021 — one in five of whom were young, and many of whom were Hispanic or Black.

“There were already large racial and ethnic disparities in deaths at younger ages, ages 25 to 64,” said Julia Raifman, a professor at Boston University’s School of Public Health and the creator and director of the COVID-19 U.S. State Policy Database. “Hispanic people [in that age group] were 30% more likely to die in 2021 than in 2019. Black people were 23% more likely to die in 2021 than in 2019 in Massachusetts.”

“That data is — honestly, sobering isn’t even the word for it — it's a little terrifying,” said Dr. Cassandra Pierre, the associate hospital epidemiologist and the medical director of public health programs at Boston Medical Center.

According to Raifman’s analysis, COVID-19 was the third leading cause of death in Massachusetts in 2021, behind cancer and heart disease. The coronavirus also accounted for the majority of the increase in the death rate for residents ages 25-64 during that time period, which was up 12%, double the overall increase in the state.

"I feel like we've been in a war and we lost our husbands."
Jane Shivick

Jane Shivick, a professional classical music singer and teacher in Worcester, was hospitalized for COVID-19 in January 2021 alongside her husband, Todd. They weren’t yet eligible for the vaccines, and like so many at the time, she wasn't able to be with Todd when he died at age 53.

“I feel like we've been in a war and we lost our husbands, because there were more men that died than women,” Shivick said. “My husband was three weeks away from getting that vaccine. He would have been one of the first ones as a human service worker. But he didn't have that chance."

The racial and age disparities seen in state-level data align with national trends recently released by the CDC. But Massachusetts did have one “success” relative to other states: fewer gun deaths, said Raifman. She was concerned gun suicides would increase during the pandemic, but the data shows that didn’t happen here.

Death rates for white and Black Massachusetts residents tracked closely for 2018 and 2019, before steeply diverging over the next two years, as death rates for white residents remained relatively flat. Increased death rates for Hispanic residents, though lower than those two other groups, tracked proportionally to the increased deaths suffered by Black residents.

A line graph shows Massachusetts death rates separated by race and ethnicity, with rates per 100,000 residents aged 25 to 64 for Black and Hispanic people climbing over the last two years, while the rates for white and Asian residents held steady.
Courtesy of Julia Raifman

Pierre said those trajectories of increased deaths in communities of color in Massachusetts pose such a serious challenge now because they cannot be addressed by focusing on COVID-19 alone.

“We have lost years out of life expectancy; it will take us some time to bring that curve down,” Pierre said. “And we know that COVID at this point is not the primary reason going forward for the death rates we're seeing in communities of color. It continues to be a significant factor, but we know that COVID is also the match that's lit [up] this really very rickety infrastructure, holding together health care access and quality for people of color. And we see that as a consequence of COVID, we have more diabetes, we have more other underlying health conditions. We have people who have progressed to more severe stages of cancer in the years that they have been unable to access health care during the height of the pandemic and continue to have intermittent access to health care. So I am really very, very worried about these numbers.”

Raifman pointed out that structural racism contributed to the vulnerabilities faced by Massachusetts communities of color in the pandemic. She said she believed certain inequities “are killing people” in the state.

“I think we have historical policies like slavery and redlining that deprived people of wealth,” Raifman said. “And we have modern day policies like a low federal minimum wage, and policies like unemployment insurance that doesn't cover everybody who needs it. And … those historical and modern-day policies combine to really make it hard for people to be healthy if they don't have resources."

Raifman and Pierre both said a pronounced reinvestment in public health in Massachusetts is necessary to start to reverse the increases in deaths in communities of color. Pierre cited the local community-level responses to the wide vaccination rate disparities seen earlier in the pandemic.

“They were utilized by many people, including the individuals who, because of structural and economic reasons, remain at high risk for being vulnerable for COVID and other infectious and chronic diseases,” Pierre said. “Because those sites were trusted and staffed with people who reflected the community and spoke the language of that community; because they were familiar.”

Pierre said those community-level responses, since mainly shut down, were also multifaceted, with not just tests or masks or vaccines being offered, but help with food and housing insecurity, as well as help for those with disability and unemployment needs. She said that kind of comprehensive approach is needed if death rates in Massachusetts are to be brought down.

Raifman also said when assessing the rising death rates in the state and how to address them, it's important “not to become numb to these numbers.”

“I know when I look at these numbers that every one of the numbers is a person,” she said, “It's worth it to come together to take care of each other when we're confronted with societal challenges like the COVID pandemic. And it's worth it to invest in each other and in health systems and public health systems and improving local public health delivery so that we can help more children grow up with their parents, more community members thrive.”