Inequities in Excess Pandemic Mortality Among Documented and Undocumented Immigrants in California, 2020-2023

Objectives. To examine how excess mortality during the COVID-19 pandemic differed by legal status and its intersections with sociodemographic factors, overall and among working-age Latinos. Methods. Using death records from Californian adults (aged ≥ 25 years) with a natural cause of death, we estimated excess mortality between March 2020 and May 2023, using ARIMA (autoregressive integrated moving average) models fit to prepandemic data spanning January 2016 through February 2020. We used country of birth and social security number (SSN) to classify decedents as US-born, foreign-born with a valid SSN ("documented"), or foreign-born without a valid SSN ("undocumented"). We assessed intersectional disparities with 5 sociodemographic factors. Results. Pandemic period relative excess mortality was twice as high among undocumented as documented immigrants. Across subgroups, undocumented Latino essential workers experienced the highest relative excess mortality (91% increase; 95% prediction interval [PI] = 60%, 138%); US-born White adults experienced the lowest relative excess mortality (8% increase; 95% PI = 3%, 14%). Conclusions. Undocumented legal status increased the risk of death during the pandemic among immigrants in California. Public Health Implications. Our findings urge attention to the exclusion of immigrants from health care and social services in the aftermath of the COVID-19 pandemic. (Am J Public Health. 2025;115(10):1681-1690. https://doi.org/10.2105/AJPH.2025.308150).