It’s not always easy to identify a COVID-19 death.

If someone dies at home, if they have symptoms not typically associated with the disease or if they die when local health systems are overwhelmed, their death certificate might say “heart disease” or “natural causes” when COVID-19 is, in fact, at fault.

New research shows such inaccuracies also are more likely for Americans who are Black, Hispanic, Asian or Native.

The true toll of the COVID-19 pandemic on many communities of color — from Portland, Oregon, to Navajo Nation tribal lands in Arizona, New Mexico and Utah, to sparsely populated rural Texas towns — is worse than previously known.

Incorrect death certificates add to the racial and ethnic health disparities exacerbated by the pandemic, which stem from long-entrenched barriers to medical care, employment, education, housing and other factors. Mortality data from the Centers for Disease Control and Prevention point to COVID-19’s disastrous impacts, in a new analysis by the Documenting COVID-19 Project at Columbia University’s Brown Institute for Media Innovation and MuckRock, in collaboration with Boston University’s School of Global Public Health; the USA TODAY Network; the Arizona Center for Investigative Reporting; Willamette Week in Portland; and the Texas Observer.

The data shows that deaths from causes the CDC and physicians routinely link to COVID — including heart disease, respiratory illnesses, diabetes and hypertension —have soared and remained high for certain racial and ethnic groups.