Abstract
IntroductionWhile the increased burden of COVID-19 among the Black population has been recognized, most attempts to quantify the extent of this racial disparity have not taken the age distribution of the population into account. In this paper, we determine the Black–White disparity in COVID-19 mortality rates across 35 states using direct age standardization. We then explore the relationship between structural racism and differences in the magnitude of this disparity across states.MethodsUsing data from the Centers for Disease Control and Prevention, we calculated both crude and age-adjusted COVID-19 mortality rates for the non-Hispanic White and non-Hispanic Black populations in each state. We explored the relationship between a state-level structural racism index and the observed differences in the racial disparities in COVID-19 mortality across states. We explored the potential mediating effects of disparities in exposure based on occupation, underlying medical conditions, and health care access.ResultsRelying upon crude death rate ratios resulted in a substantial underestimation of the true magnitude of the Black–White disparity in COVID-19 mortality rates. The structural racism index was a robust predictor of the observed racial disparities. Each standard deviation increase in the racism index was associated with an increase of 0.26 in the ratio of COVID-19 mortality rates among the Black compared to the White population.ConclusionsStructural racism should be considered a root cause of the Black–White disparity in COVID-19 mortality. Dismantling the long-standing systems of racial oppression is critical to adequately address both the downstream and upstream causes of racial inequities in the disease burden of COVID-19.
Highlights
Introduction While the increased burden ofCOVID-19 among the Black population has been recognized, most attempts to quantify the extent of this racial disparity have not taken the age distribution of the population into account
Using linear regression analysis, we explored the potential mediating effects of three variables identified in the literature as possible explanations for observed racial disparities in COVID-19 mortality: disparities in exposure based on occupation; disparities in weathering effects based on the presence of underlying medical conditions that could increase COVID-19 severity; and disparities in health care access
This shows that relying on the crude death rates results in a marked underestimation of the magnitude of the racial disparity in COVID19 mortality between the Black and White populations
Summary
Introduction While the increased burden ofCOVID-19 among the Black population has been recognized, most attempts to quantify the extent of this racial disparity have not taken the age distribution of the population into account. We determine the Black–White disparity in COVID-19 mortality rates across 35 states using direct age standardization. No country in the world has suffered a greater burden from COVID-19 mortality than the USA, which has experienced 534,000 deaths as of the middle of March 2021, accounting for 19.6% of the worldwide total [1]. Within the USA, the burden of COVID-19 death has not been experienced by all racial/ethnic groups. Many studies have investigated the overall national racial disparity in COVID-19 mortality, few have explicitly compared race-specific mortality rates within states. Racial and Ethnic Health Disparities many studies have suggested a role for structural racism in explaining these disparities, few have empirically demonstrated such a connection by attempting to quantify structural racism as a specific measure
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