Abstract
BackgroundCommunities with more Black or Hispanic residents have higher coronavirus rates than communities with more White residents, but relevant community characteristics are underexplored. The purpose of this study was to investigate poverty-, race- and ethnic-based disparities and associated economic, housing, transit, population health and health care characteristics.MethodsSix-month cumulative coronavirus incidence and mortality were examined using adjusted negative binomial models among all U.S. counties (n = 3142). County-level independent variables included percentages in poverty and within racial/ethnic groups (Black, Hispanic, Native American, Asian), and rates of unemployment, lacking a high school diploma, housing cost burden, single parent households, limited English proficiency, diabetes, obesity, smoking, uninsured, preventable hospitalizations, primary care physicians, hospitals, ICU beds and households that were crowded, in multi-unit buildings or without a vehicle.ResultsCounties with higher percentages of Black (IRR = 1.03, 95% CI: 1.02–1.03) or Hispanic (IRR = 1.02, 95% CI: 1.01–1.03) residents had more coronavirus cases. Counties with higher percentages of Black (IRR = 1.02, 95% CI: 1.02–1.03) or Native American (IRR = 1.02, 95% CI: 1.01–1.04) residents had more deaths. Higher rates of lacking a high school diploma was associated with higher counts of cases (IRR = 1.03, 95% CI: 1.01–1.05) and deaths (IRR = 1.04, 95% CI: 1.01–1.07). Higher percentages of multi-unit households were associated with higher (IRR = 1.02, 95% CI: 1.01–1.04) and unemployment with lower (IRR = 0.96, 95% CI: 0.94–0.98) incidence. Higher percentages of individuals with limited English proficiency (IRR = 1.09, 95% CI: 1.04–1.14) and households without a vehicle (IRR = 1.04, 95% CI: 1.01–1.07) were associated with more deaths.ConclusionsThese results document differential pandemic impact in counties with more residents who are Black, Hispanic or Native American, highlighting the roles of residential racial segregation and other forms of discrimination. Factors including economic opportunities, occupational risk, public transit and housing conditions should be addressed in pandemic-related public health strategies to mitigate disparities across counties for the current pandemic and future population health events.
Highlights
Communities with more Black or Hispanic residents have higher coronavirus rates than communities with more White residents, but relevant community characteristics are underexplored
During the first 6 months of the U.S coronavirus epidemic, counties with higher rates of Black or Hispanic residents had higher cumulative incidence and counties with higher rates of Black or Native American residents had higher cumulative coronavirus-related mortality. These results are consistent with those of other studies reviewed earlier showing coronavirus disparities based on Black race and Hispanic ethnicity and build on prior work by identifying disparities based on proportion of Native American residents
Prior studies have documented disparities for multiple other health outcomes [27, 28] for Native American communities and these results show the emergence of coronavirus disparities within the first 6 months of the epidemic
Summary
Communities with more Black or Hispanic residents have higher coronavirus rates than communities with more White residents, but relevant community characteristics are underexplored. The purpose of this study was to investigate poverty-, race- and ethnic-based disparities and associated economic, housing, transit, population health and health care characteristics. Prior studies have not accounted for other relevant demographic factors, including population age, sex, or non-White and non-Black racial groups. This information is needed to identify community characteristics that are potential risk factors of disparities relevant to the novel coronavirus. Disparities are likely attributable to the persistent effects of residential racial segregation and concentrated poverty, which likely influence multiple relevant risk factors [9, 10], including economic, housing, population health and health care characteristics. Individuals living on incomes below poverty, or racial and ethnic minorities may have a higher risk of severe illness or mortality [13] because of their greater burden of underlying chronic diseases [14,15,16,17], and lack of health care access [18]
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