Deaths among most racial and ethnic minority groups in the U.S. increased faster than deaths among Whites during the first year of the COVID-19 pandemic. But not all the differences resulted from the disease itself, a new study finds.

The study, published as a Research Letter in JAMA Internal Medicine, examines race- and ethnic-based disparities in excess deaths—the difference between forecasted and observed deaths—from “external causes” (causes other than COVID-19) between March and December, 2020. These included drug overdoses, homicides, suicides, and deaths from transportation-related causes.

The racial/ethnic groups included in the study were American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, Hispanic or Latino, and White.

The authors applied regression models to monthly death count data from the Centers for Disease Control and Prevention from January 2015 to February 2020 to forecast deaths during the study period. Then they subtracted the number of forecast deaths from the number of observed deaths to arrive at excess deaths.

The total of excess external deaths for the period, they estimate, was 17,251 (241,566 observed versus 224,315 predicted deaths), or 5.24 per 100,000 population. Among racial/ethnic groups, the highest rate—17.66 per 100,000—was among American Indians/Alaskan Natives. That was followed by Blacks/African-Americans (15.41), Whites, Hispanics/Latinos (3.81), Whites (3.77), and Asians/Pacific Islanders (0.27).

Broken down by category, the largest proportion of excess eternal deaths resulted from drug overdoses, which occurred at an overall rate of 3.92 per 100,000 population. American Indians/Alaska natives experienced the highest rate of overdose deaths, 11.21 per 100,000, followed by Blacks/African Americans (5.59) and Whites (3.66).

In the homicide category, Blacks/African Americans experienced the highest rate at 6.7 per 100,000, followed by American Indians/Alaskan Natives (3.02), and Hispanics/Latinos (0.97). The overall rate was 1.31.

For suicides, American Indians/Alaska natives was the only group to experience excess deaths, which occurred at a rate of 1.88 per 100,000. The overall rate was 0.74 (38,268 observed versus 40,690 forecasted.)

The highest rate of transportation-related deaths, 2.92 per 100,000, was among Blacks/African-Americans, followed by Hispanics/Latinos (0.76) and Whites (0.31), with an overall rate of 0.67.

The authors attribute the disparities in excess deaths to structural racism, noting that “discrimination against Black and American Indian or Alaska Native populations has left these communities especially vulnerable to the consequences of the pandemic” in areas such as unemployment, housing and food instability, and access to health care.

The study, “Racial and Ethnic Disparities in Estimated Excess Mortality From External Causes in the U.S., March to December 2020,” was published online May 9.