For most of 2020, SARS-CoV-2 (COVID-19) assaulted United States (U.S.) economic and cultural practices. By late summer, the virus aggressively pushed its way into the leading causes of mortality, accounting for 1 in 8 deaths in the country (1). Simultaneously other death causes increased (2) as mental health concerns soared (3), and decreased access to health care left many uncertain about best practices in maintaining and addressing physical health. While the long-term repercussions of COVID-19 will be studied for decades, one clear effect is an increase in bereavement.

Early estimates show that for each COVID-19 death, nine close friends and family members are bereaved, including thousands of children under 18 (4). Early in the pandemic, virus-related mortality overwhelmingly impacted older adults aged 70 and over—individuals less likely to have children 0–17. As the pandemic continued, the novel coronavirus mutated, and new variants emerged. Late in 2020 and throughout 2021, despite the availability of vaccines, mortality due to the virus increased, the average age of death attributed to the virus decreased (5), and bereavement rates for children under 18 grew steadily. The pandemic's impacts on bereavement reached well beyond direct mortality due to COVID-19, as increases were noted in other leading causes of death. For example, U.S. mortality due to accidental drug overdose has risen for the past two decades, yet overdose deaths spiked more than 31% in 2020, the first year of the pandemic (6). This trend continued in 2021 when the age-adjusted rate of overdose deaths increased by 14% compared to 2020 (7). Similar findings from 2020 to 2021 demonstrate greater than expected adult mortality in all disease conditions except cancer, with the largest increases resulting from accidents, including injuries, assaults, and homicides (8).

The death of a parent during childhood is an adverse experience that increases risks for future behavioral health (9–12), academic (13), and relational problems (14), as well as suicide (15) and earlier mortality (16). Given the potential for disruptive grief reactions with significant short- and long-term consequences, the American Psychiatric Association included Prolonged Grief Disorder in a 2022 text revision of the Diagnostic and Statistical Manual 5, including developmental considerations for children and adolescents (17). The concept of grief as a “disorder” is widely debated in the childhood bereavement field. Estimates show that 10% (18) to 18% (19) of bereaved youth meet the criteria for a diagnosis. Most bereaved children look to their caregivers, peers, and community for support to navigate loss. A recent systematic literature review reflects positive outcomes for bereaved children following participation in preventative interventions aimed at promoting healthy adaptation to the death of a parent (20). Despite this evidence, there is limited access to preventive interventions that have the potential to reduce risk and promote well-being in bereaved youth and families (21). These resources are even more limited in communities with scarce financial, social, and health safety nets.

Despite the clear evidence that childhood bereavement can lead to negative outcomes, efforts to estimate childhood bereavement prevalence rates have been hampered by methodological, reporting, and data source limitations. In the absence of national bereavement tracking systems in the U.S., a statistical estimation model was developed to quantify this public health issue. The Childhood Bereavement Estimation Model (CBEM) is a theory-based probability model incorporating life-table modeling techniques. Burns et al. (22) describe how the CBEM evaluates an input dataset of age-based population, mortality, and natality data for distinct geographies to generate estimates. The CBEM uses publicly available data and incorporates a series of assumptions to derive bereavement estimates. Model results demonstrate fluctuations in childhood bereavement prevalence related to geographic location, age, population density, cause of death, and race and ethnicity. The CBEM offers social service, community support, and health professionals a tool for raising awareness about the magnitude of childhood bereavement and assessing the need for grief services within specific localities. CBEM results ultimately play a role in equipping communities to develop effective preventive bereavement interventions for children that are inclusive and accessible.

Pre-pandemic CBEM results demonstrated that Black and Indigenous children comprise a disproportionate share of bereaved youth in the U.S. (23). For example, Black youth accounted for 16.7% of the U.S. population under age 18, yet they made up 23.9% of bereaved children, a 43% overrepresentation. Analyzing CDC provisional death data from February 2020 to January 2021, Kidman and colleagues (24) estimated a 17.5%–20.2% increase in childhood bereavement due to parent death absent COVID-19. In a study aimed at quantifying COVID-19-associated orphanhood, Hillis et al. (25) demonstrated that the likelihood of experiencing parent or grandparent death due to COVID-19 was up to 4.5 times higher for children of color when compared to non-Hispanic white peers.

The current study analyzed annual childhood bereavement rates from the death of a parent from 2016 to 2021 using the CBEM and compared results from the 2 years of the pandemic (2020 and 2021) to the preceding 4 years (2016–2019) for all U.S. children 0 to 17. Further, the analyses explored the differential toll of bereavement on children based on race and Hispanic origin. Results address increases in bereavement, directly and indirectly, connected to COVID-19. Recommendations for prevention and intervention efforts are offered.

Since the initial CBEM publication (22), the model has been updated and refined to increase accuracy. An online CBEM technical appendix documents changes over time that includes quantitative techniques, information sources, and processing approaches (26). Table 1 details the changes relevant to the current analyses examining bereavement in childhood due to parent death.

In addition to the assumptions outlined by Burns et al. (22), the current analyses assume a child and their parents all identify with the same race and Hispanic origin. More than 85% of the 5.5 million first live births for the years 2016–2020, with details for both the mother's and father's race and Hispanic origin were born to a mother and father of the same race and Hispanic origin categories (27). While this assumption is restrictive, it is generally representative of most children born in the U.S.

Figure 1 reflects the disproportionate impact of pandemic bereavement on children of color by displaying the single-year snapshot results for the percentage of the total population of children under 18 in each population category who were newly bereaved in the years 2016–2021. All categories saw increased bereavement in the first and second years of the pandemic. The 2020 U.S. Census allowed respondents to choose more than one race category. Thus, childhood bereavement results for this population are only reported in 2021. In line with previous CBEM results, non-Hispanic American Indian Alaska Native, and non-Hispanic Black youth have the highest bereavement rates across years with 10.0% and 6.4% of the total population of youth in these categories, respectively. Likewise, these two groups experienced the steepest increases in the first 2 years of the pandemic.

Table 2 presents the 1-year snapshot results for newly bereaved children by population group for 2020 with more than 65,000 additional children newly bereaved compared to the annual average from 2016 to 2019, a 24.9% increase. The probability of observing 2020 counts assuming the 2016–2019 distribution is small (<5%) for all race and Hispanic origin groups. Although non-Hispanic white children saw the largest increase in newly bereaved children in 2020 (22,973), the findings are more nuanced. Non-Hispanic white youth experienced the smallest percentage increase in bereavement in 2020 (14.9%) relative to the 2016–2019 annual average. In contrast, Hispanic Asian Pacific Islander (72.0%) and Hispanic Black (72.4%) youth experienced the largest percentage increases. Table 2 also shows that these percentage increases are larger for Hispanic youth across all race groups. Given changes in the 2020 U.S. Census categorization of race, 2021 CBEM results were not analyzed compared to 2016–2020 data. Table 3 has the complete results for the number of newly bereaved children by race and Hispanic origin group for each year from 2016 to 2021.

In a new application of the CBEM, results quantify one aspect of the COVID-19 pandemic's devastating impact on the U.S. Comparisons of CBEM results from 2020 to 2021 to results from the previous 4 years (2016–2019) clearly highlight the toll of the pandemic on childhood bereavement while also stressing the significance of the issue in the preceding years. Results demonstrate how the pandemic's initial bereavement impacts compounded existing rates of annual bereavement that averaged more than 260,000 children under age 18 being newly bereaved from the death of a parent each year. This number increased by nearly 50%, jumping to more than 383,000 by the end of 2021. The increased childhood bereavement rates were not only attributed to climbing mortality directly connected to COVID-19, but also to indirect impacts of pandemic stress and strain that resulted in rising mortality due to a range of causes such as overdose and homicide death rates. Indeed in 2020, one in five children bereaved by the death of a parent experienced an overdose loss (32). These stigmatized losses may result in increased isolation, guilt, and uncertainty for grieving families.

The nuances revealed by the current analyses show disproportionate increases in bereavement in communities of color. For example, in the first year of the pandemic, compared to the previous 4-year average, rates of childhood bereavement increased by 50% percent or more for all children identified as Hispanic or Latino, regardless of their race, yet the largest jumps were among Hispanic or Latino youth who also identified as Indigenous, Black, and Asian. As the pandemic stretched into 2021, rates of childhood bereavement continued to soar, particularly among Indigenous and Black youth. These analyses show a grim reality where roughly one in ten non-Hispanic Indigenous children under 18 experienced the death of a parent in 2021. Although the current results do not provide data on the cause of these startling differences, the cultural climate of systemic racism and historic oppression are possible contributors. For example, from the start of the pandemic, xenophobic suppositions regarding the origins of COVID-19 fueled anti-Asian sentiment nationwide that contributed to rising rates of depression and anxiety in this community (33). Systemic injustice and lack of access to quality health care contribute to stark inequities that likely resulted in disproportionate death rates for preventable death causes such as heart disease, liver disease, and homicide in communities of color (23).

The current study has important data and methodological differences from other studies of COVID-attributable bereavement or orphanhood in the U.S. (24, 25, 34). First, this study incorporates final, validated CDC WONDER data instead of preliminary estimates. Second, the CBEM results presented here are specific to children grieving the death of a parent. In contrast, prior studies investigated family characteristics or used dynamic family/community models considering bereavement for children raised by non-parent caregivers. Third, the current study's exploration of population subgroups considering race and Hispanic origin provides novel results emphasizing the context of the pandemic's impact on childhood bereavement and aiding resource allocation to provide support. The race and Hispanic origin results demonstrate how the pandemic exacerbated longstanding discrepancies in the magnitude of childhood bereavement for non-white youth.