Disparities In COVID-19 Deaths Research Articles

Frames of war and welfare

Frames of war and welfare

An exploration of structural determinants driving racial disparities in COVID-19 deaths in Michigan.

Racial disparities in COVID-19 death rates have largely been driven by structural racism in health, housing, and labor systems that place Black, Brown, and Indigenous populations at greater risk for COVID-19 exposure, transmission, and severe illness, compared to non-Hispanic White populations. Here we examine the association between taxable property values per capita, an indicator influenced by historical and contemporary housing policies that have disproportionately impacted people of color, and COVID-19 deaths. Taxable values serve as a proxy for fiscal health providing insight on the county's ability to address imminent needs, including COVID-19 responses. Therefore, higher taxable values indicate local governments that are better equipped to deliver these public services. We used county-level data from the American Community Survey, the Michigan Community Financial Dashboard, The Atlantic's COVID Tracking Project, and the Community Health Rankings and Roadmap for this cross-sectional study. Maps were created to examine the geographic distribution of cumulative death rates and taxable values per capita, and regression models were used to examine the association between the two while controlling for population density, age, education, race, income, obesity, diabetes, and smoking rates. Seventy-five counties were included. The mean taxable value per capita was $43,764.50 and the mean cumulative death rate was 171.86. Findings from the regression analysis showed that counties with higher taxable values were associated with lower COVID-19 death rates (B = -2.45, P < 0.001). Our findings reveal a need to reevaluate current policies surrounding taxable property values in the state of Michigan, not solely for theirinequitable impact on local governments' financial solvency and service quality, but also for their negativeconsequences for population health andracial health equity. The online version contains supplementary material available at 10.1007/s10389-022-01817-w.

Association of Zip Code Vaccination Rate With COVID-19 Mortality in Chicago, Illinois

There has been large geographic inequity in vaccination coverage across Chicago, Illinois, with higher vaccination rates in zip codes with residents who predominantly have high incomes and are White. To determine the association between inequitable zip code-level vaccination coverage and COVID-19 mortality in Chicago. This retrospective cohort study used Chicago Department of Public Health vaccination and mortality data and Cook County Medical Examiner mortality data from March 1, 2020, through November 6, 2021, to assess the association of COVID-19 mortality with zip code-level vaccination rates. Data were analyzed from June 1, 2021, to April 13, 2022. Zip code-level first-dose vaccination rates before the Alpha and Delta waves of COVID-19. The primary outcome was deaths from COVID-19 during the Alpha and Delta waves. The association of a marginal increase in zip code-level vaccination rate with weekly mortality rates was estimated with a mixed-effects Poisson regression model, and the total number of preventable deaths in the least vaccinated quartile of zip codes was estimated with a linear difference-in-difference design. The study population was 2 686 355 Chicago residents in 52 zip codes (median [IQR] age 34 [32-38] years; 1 378 658 [51%] women; 773 938 Hispanic residents [29%]; 783 916 non-Hispanic Black residents [29%]; 894 555 non-Hispanic White residents [33%]). Among residents in the least vaccinated quartile, 80% were non-Hispanic Black, compared with 8% of residents identifying as non-Hispanic Black in the most vaccinated quartile (P < .001). After controlling for age distribution and recovery from COVID-19, a 10-percentage point increase in zip code-level vaccination 6 weeks before the peak of the Alpha wave was associated with a 39% lower relative risk of death from COVID-19 (incidence rate ratio [IRR], 0.61 [95% CI, 0.52-0.72]). A 10-percentage point increase in zip code vaccination rate 6 weeks before the peak of the Delta wave was associated with a 24% lower relative risk of death (IRR, 0.76 [95% CI, 0.66-0.87]). The difference-in-difference estimate was that 119 Alpha wave deaths (72% [95% CI, 63%-81%]) and 108 Delta wave deaths (75% [95% CI, 66%-84%]) might have been prevented in the least vaccinated quartile of zip codes if it had had the vaccination coverage of the most vaccinated quartile. These findings suggest that low zip code-level vaccination rates in Chicago were associated with more deaths during the Alpha and Delta waves of COVID-19 and that inequitable vaccination coverage exacerbated existing racial and ethnic disparities in COVID-19 deaths.

Provisional COVID-19 Age-Adjusted Death Rates, by Race and Ethnicity - United States, 2020-2021.

Disparities in COVID-19 death rates by race and ethnicity have been reported in the United States (1,2). In response to these disparities, preventive, medical care, and social service assistance programs were implemented to lessen disparities in COVID-19 outcomes, including grants to support state, tribal, local, and territorial health department responses (3). The potential impact of such efforts on annual changes in racial and ethnic disparities in mortality rates that identify COVID-19 as the underlying cause of death has not been previously reported. This analysis used U.S. provisional mortality data from death certificates collected by CDC's National Vital Statistics System (NVSS) to estimate changes in COVID-19-related age-adjusted death rates (AADRs) by race and ethnicity during 2020-2021. Compared with non-Hispanic multiracial persons (the group with the lowest death rate), significant decreases in AADR ratios occurred during 2020-2021 among non-Hispanic American Indian or Alaska Native (AI/AN) persons (34.0%), non-Hispanic Asian (Asian) persons (37.6%), non-Hispanic Black or African American (Black) persons (40.2%), Hispanic persons (37.1%), and non-Hispanic White (White) persons (14%); a non-statistically significant 7.2% increase in AADR ratio occurred among non-Hispanic Native Hawaiian or other Pacific Islander (NH/OPI) persons. Despite reductions in AADR disparities from 2020 to 2021, large disparities in AADR by race and ethnicity remained in 2021. Providing effective preventive interventions, including vaccination and clinical care, to all communities in proportion to their need for these interventions is necessary to reduce racial and ethnic disparities in COVID-19 deaths.

The Relationship between Systemic Racism, Residential Segregation, and Racial/Ethnic Disparities in COVID-19 Deaths in the United States.

Although Black Americans are not substantially more likely to be diagnosed with COVID-19, hospitalization rates and death rates are considerably higher than for White Americans. The aim of this study was to assess the relationship between systemic racism generally, and residential segregation in particular, and racial/ethnic disparities in deaths due to COVID-19. To assess racial disparities in COVID-19 and systemic racism in US states, we calculated descriptive statistics and bivariate Pearson correlations. Using data on deaths through December 2020, we developed a weighted logistic mixed model to assess whether state-level systemic racism generally and residential segregation, in particular, predicted the probability of COVID-19 deaths among Americans, considering key sociodemographic factors. Residential segregation is a stronger predictor of COVID-19 deaths among Black Americans, as compared to systemic racism more generally. Looking at the interaction between residential segregation and COVID-19 death rates by race, residential segregation is associated with negative outcomes for Black and White Americans, but disproportionately impacts Black state residents (P<.001), who have 2.14 times higher odds of dying from COVID-19 when residential segregation is increased. To understand and address disparities in infectious disease, researchers and public health practitioners should acknowledge how different forms of systemic racism shape health outcomes in the United States. More attention should be given to the mechanisms by which infectious disease pandemics exacerbate health disparities in areas of high residential segregation and should inform more targeted health policies. Such policy changes stand to make all American communities more resilient in the face of new and emerging infectious diseases.

Disparities in COVID-19 Mortality in High-Minority Nursing Homes

Racial/ethnic disparities in healthcare have been highlighted by the recent COVID-19 pandemic. Minorities continue to utilize nursing home services at a higher rate than White residents, contributing to existing health inequity concerns. This study examined the relationship between nursing home racial/ethnic mix and COVID-19 resident mortality using the CMS Nursing Home COVID-19 Public File. As of October 25, 2020, high minority nursing homes reported 6.5 COVID-19 deaths as compared to 2.6 deaths for nursing homes that had no racial/ethnic minorities. Four nested sequential negative binomial regressions were used to model the relationship between racial/ethnic disparities in COVID-19 deaths and the separate contributions of facility-level resident characteristics (percent of females, percent of residents 65 years and older, percent of residents with congestive heart failure, hypertension, and obesity, and the average level of residents’ acuity), resource availability (nursing homes’ payer-mix, occupancy rate, county-level Social Deprivation Index, and nursing home location), and other organizational characteristics (nursing home for-profit status, chain affiliation, and self-reported nursing, clinical, aides, and other staff shortages). After controlling for interstate differences, facility-level resident characteristics, resource availability, and organizational characteristics, high-minority nursing homes had 61% more COVID-19 deaths (Incidence Rate Ratio [IRR] = 1.61; p < 0.001) as compared to nursing facilities with no minorities. From a policy perspective, nursing homes, that serve primarily minority populations, may need additional resources, such as, funding for staffing and equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the long-term care.

Do Black Lives Matter in the American Public's Mitigation Responses to the COVID-19 Pandemic? An Analysis of Mask Wearing and Racial/Ethnic Disparities in Deaths from COVID-19.

BackgroundMask wearing has varied considerably throughout the COVID-19 pandemic and has been most often associated with political affiliation and specific health beliefs. The purpose of this study was to determine the relationship between mask usage, neighborhood racial segregation, and racial disparities in COVID-19 deaths.MethodsWe used linear regression to assess whether the racial/ethnic composition of deaths and residential segregation predicted Americans’ decisions to wear masks in July 2020.ResultsAfter controlling for mask mandates, mask usage increased when White death rates relative to Black and Hispanic rates increased.ConclusionsMask wearing may be shaped by an insensitivity to Black and Hispanic deaths and a corresponding unwillingness to engage in health-protective behaviors. The broader history of systemic racism and residential segregation may also explain why white Americans do not wear masks or perceive themselves to be at risk when communities of color are disproportionately affected by COVID-19.

Sex Disparities in COVID-19 Mortality Vary Across US Racial Groups.

BackgroundInequities in COVID-19 outcomes in the USA have been clearly documented for sex and race: men are dying at higher rates than women, and Black individuals are dying at higher rates than white individuals. Unexplored, however, is how sex and race interact in COVID-19 outcomes.ObjectiveUse available data to characterize COVID-19 mortality rates within and between race and sex strata in two US states, with the aim of understanding how apparent sex disparities in COVID-19 deaths vary across race.Design and ParticipantsThis observational study uses COVID-19 mortality data through September 21, 2020, from Georgia (GA) and Michigan (MI).Main MeasuresWe calculate age-specific rates for each sex-race-age stratum, and age-standardized rates for each race-sex stratum. We investigate the sex disparity within race groups and the race disparity within sex groups using age-standardized rate ratios, and rate differences.Key ResultsWithin race groups, men have a higher COVID-19 mortality rate than women. Black men have the highest rate of all race-sex groups (in MI: 254.6, deaths per 100,000, 95% CI: 241.1–268.2, in GA:128.5, 95% CI: 121.0-135.9). In MI, the COVID-19 mortality rate for Black women (147.1, 95% CI: 138.7–155.4) is higher than the rate for white men (39.1, 95% CI: 37.3–40.9), white women (29.7, 95% CI: 28.3–31.0), and Asian/Pacific Islander men and women. COVID-19 mortality rates in GA followed the same pattern. In MI, the male:female mortality rate ratio among Black individuals is 1.7 (1.5–2.0) while the rate ratio among White individuals is only 1.3 (1.2–1.5).ConclusionWhile overall, men have higher COVID-19 mortality rates than women, our findings show that this sex disparity does not hold across racial groups. This demonstrates the limitations of unidimensional reporting and analyses and highlights the ways that race and gender intersect to shape COVID-19 outcomes.

Disparities in COVID-19 deaths by country of birth in Stockholm, Sweden: A total population based cohort study.

Preliminary evidence points to higher morbidity and mortality of covid-19 in certain racial and ethnic groups but population-based studies using micro-level data are so far lacking. We examined disparities in covid-19 deaths by region/country of birth and studied whether migrants’ socioeconomic and living conditions attenuated such disparities. A register-based cohort including all adults living in Stockholm, Sweden (n=2,365,434) between January 31st (date of first confirmed case) and May 4th 2020 was utilized. Poisson regressions with region/country of birth as exposure and underlying cause of death by Covid-19 was performed. Migrants from Middle-Eastern countries (RR 3.2, 95% CI: 2.6-3.8), Africa (RR 3.0, 95% CI: 2.2-4.3) and the Nordic countries (RR 1.5, 95% CI: 1.2-1.8) had higher mortality in covid-19 when compared to Swedish born. Especially high mortality risks from covid-19 was found among individuals born in Somalia (RR 8.9, 95% CI: 5.6-14.0), Lebanon (RR 5.9, 95% CI: 3.4-10.3), Syria (RR 4.7, 95% CI: 3.3-6.6), Turkey (RR 3.1, 95% CI: 2.1-4.4), Iran (RR 2.6, 95% CI: 1.7-3.8) and Iraq (RR 2.4, 95% CI: 1.7-3.5). Socioeconomic status, number of working age household members and neighborhood population density attenuated up to half of the increased covid-19 mortality risks among foreign born, although a sizable amount of excess mortality remained in all groups. We found large disparities in covid-19 mortality by country of birth in Stockholm, one of the most affected regions in the world. Disadvantaged socioeconomic and living conditions may increase infection rates in migrants and contribute to their higher covid-19 mortality risk.

Racial, ethnic, and socioeconomic disparities in confirmed COVID-19 cases and deaths in the United States: a county-level analysis as of November 2020

ABSTRACT Objectives The objective of this study was to investigate potential county-level disparities among racial/ethnic and socioeconomic groups in confirmed COVID-19 cases and deaths in the United States in 100,000 population. Design Secondary data analysis using county-level data for 3,142 US counties was conducted in 2020. Hierarchical linear regression and concentration curve analyses were performed. The combined association of COVID-19 cases and deaths was examined separately by the county population's socioeconomic characteristics. Data from the American Community Survey (ACS) 5-year estimates (2014–2018), Area Health Resources File (AHRF) 2018–2019, Kaiser Health News 2020, and 2020 COVID-19 data from Johns Hopkins University were used in this study. Results After adjusting for covariates, U.S. counties with a higher proportion of the Black population and a higher proportion of adults with less than a high school diploma had disproportionately higher COVID-19 cases and deaths (β > 0, p<0.05 for all relations). A higher proportion of the Hispanic population was associated with higher confirmed cases (β = 0.68, 95% CI = 0.48–0.87). The majority observed disparities in COVID-19 deaths persisted even after controlling for all-cause deaths in 2019 and COVID-19 cases per 100,000 county population. This can potentially aggravate the existing health disparities among these population groups. Conclusions Identification of disproportionately impacted population groups can pave the way towards narrowing the disparity gaps and guide policymakers and stakeholders in designing and implementing population group-specific interventions to mitigate the negative consequences of the COVID-19 pandemic.