ABSTRACT
We examined the all-cause and COVID-19-specific mortality among World Trade Center Health Registry (WTCHR) enrollees. We also examined the socioeconomic factors associated with COVID-19-specific death. Mortality data from the NYC Bureau of Vital Statistics between 2015-2020 were linked to the WTCHR. COVID-19-specific death was defined as having positive COVID-19 tests that match to a death certificate or COVID-19 mentioned on the death certificate via text searching. We conducted step change and pulse regression to assess excess deaths. Limiting to those who died in 2019 (n = 210) and 2020 (n = 286), we examined factors associated with COVID-19-specific deaths using multinomial logistic regression. Death rate among WTCHR enrollees increased during the pandemic (RR: 1.70, 95% CL: 1.25-2.32), driven by the pulse in March-April 2020 (RR: 3.38, 95% CL: 2.62-4.30). No significantly increased death rate was observed during May-December 2020. Being non-Hispanic Black and having at least one co-morbidity had a higher likelihood of COVID-19-associated mortality than being non-Hispanic White and not having any co-morbidity (AOR: 2.43, 95% CL: 1.23-4.77; AOR: 2.86, 95% CL: 1.19-6.88, respectively). The racial disparity in COVID-19-specific deaths attenuated after including neighborhood proportion of essential workers in the model (AOR:1.98, 95% CL: 0.98-4.01). Racial disparities continue to impact mortality by differential occupational exposure and structural inequality in neighborhood representation. The WTC-exposed population are no exception. Continued efforts to reduce transmission risk in communities of color is crucial for addressing health inequities.