Disparities In COVID-19 Mortality Research Articles

Polarized Perspectives on Health Equity: Results from a Nationally Representative Survey on US Public Perceptions of COVID-19 Disparities in 2023.

Republicans and Democrats responded to the COVID-19 pandemic in starkly different ways, from their attitudes in 2020 about whether the virus posed a threat to whether the pandemic ended in 2023. The consequences of COVID-19 for health equity have been a central concern in public health, and the concept of health equity has also been beset by partisan polarization. In this article, the authors present and discuss nationally representative survey data from 2023 on US public perceptions of disparities in COVID-19 mortality (building on a previous multiwave survey effort) as well as causal attributions for racial disparities, the contribution of structural racism, and broader attitudes about public health authority. The authors find anticipated gulfs in perspectives between Democrats on the one hand and independents and Republicans on the other. The results offer a somewhat pessimistic view of the likelihood of finding common ground in how the general public understands health inequities or the role of structural racism in perpetuating them. However, the authors show that those who acknowledge racial disparities in COVID-19 are more likely to support state public health authority to act in response to other infectious disease threats. The authors explore the implications of these public opinion data for advocacy, communication, and future needed research.

Racial and Ethnic Disparities in COVID-19 Mortality

This cross-sectional study examines racial and ethnic differences in COVID-19 mortality in the United States across 4 case surges between February 2020 and September 2023.

Urban-rural disparities in COVID-19 hospitalisations and mortality: A population-based study on national surveillance data from Germany and Italy.

Recent literature has highlighted the overlapping contribution of demographic characteristics and spatial factors to urban-rural disparities in SARS-CoV-2 transmission and outcomes. Yet the interplay between individual characteristics, hospitalisation, and spatial factors for urban-rural disparities in COVID-19 mortality have received limited attention. To fill this gap, we use national surveillance data collected by the European Centre for Disease Prevention and Control and we fit a generalized linear model to estimate the association between COVID-19 mortality and the individuals' age, sex, hospitalisation status, population density, share of the population over the age of 60, and pandemic wave across urban, intermediate and rural territories. We find that in what type of territory individuals live (urban-intermediate-rural) accounts for a significant difference in their probability of dying given SARS-COV-2 infection. Hospitalisation has a large and positive effect on the probability of dying given SARS-CoV-2 infection, but with a gradient across urban, intermediate and rural territories. For those living in rural areas, the risk of dying is lower than in urban areas but only if hospitalisation was not needed; while for those who were hospitalised in rural areas the risk of dying was higher than in urban areas. Together with individuals' demographic characteristics (notably age), hospitalisation has the largest effect on urban-rural disparities in COVID-19 mortality net of other individual and regional characteristics, including population density and the share of the population over 60.

Widening Disparities in COVID-19 Mortality and Life Expectancy Among 15 Major Racial and Ethnic Groups in the United States, 2020-2021.

Persistent and often widening racial/ethnic and socioeconomic inequalities in health have long existed in the US. Although racial/ethnic disparities in COVID-19 mortality are well documented, COVID-19 mortality risks and resultant reductions in life expectancy during the pandemic for detailed racial and ethnic groups in the US, including Asian and Hispanic subgroups, are not known. We used 2020-2021 US mortality data to estimate age-adjusted COVID-19 mortality rates, life expectancy, and the consequent declines in life expectancy due to COVID-19 overall and for the 15 largest racial/ethnic groups. We used standard life table methodology, cause-elimination life tables, and inequality indices to analyze trends in racial/ethnic disparities. The number of COVID-19 deaths increased from 350,827 in 2020 to 416,890 in 2021. COVID-19 death rates varied 7-fold among the racial/ethnic groups; Japanese and Chinese had the lowest mortality rates and Mexicans and American Indians/Alaska Natives (AIANs) had the highest rates. In 2021, life expectancy ranged from 70.3 years for Blacks and 70.6 years for AIANs to 85.2 years for Japanese and 87.7 years for Chinese. The life-expectancy gap was wide- 22.4 years in 2020 and 23.2 years in 2021. COVID-19 mortality had the greatest impact in reducing the life expectancy of Mexicans (3.53 years in 2020 and 3.78 years in 2021), Central/South Americans (4.86 years in 2020 and 3.50 years in 2021), and AIANs (2.51 years in 2020 and 2.38 years in 2021). Racial/ethnic inequalities in COVID-19 mortality, life expectancy, and resultant reductions in life expectancy during the pandemic widened between 2020 and 2021.

Understanding Racial/Ethinic Disparities in COVID Mortality Using a Novel Metric: COVID Excess Mortality Percentage.

Prior research on racial/ethnic disparities in COVID-19 mortality has often not considered to what extent they reflect COVID-19-specific factors, versus preexisting health differences. This study examines how racial/ethnic disparities in COVID-19 mortality vary with age, gender, and time period over April - December 2020 in the US, using mortality from other natural causes to proxy for underlying health. We study a novel measure, the COVID Excess Mortality Percentage (CEMP), defined as the COVID-19 mortality rate, divided by the non-COVID natural mortality rate, converted to a percentage, where the CEMP denominator, controls, albeit imperfectly, for differences in population health. Disparities measured using CEMP deviate substantially from those in prior research. In particular, we find very high disparities (up to 12:1) in CEMP rates for Hispanics versus Whites, particularly for non-elderly men. Asians also have elevated CEMP rates versus Whites, which were obscured in prior work by lower overall Asian mortality. Native Americans and Blacks have significant disparities compared to Whites populations, but CEMP ratios to Whites are lower than ratios reported in other work. This is because the higher COVID-19 mortality for Blacks and Native Americans comes partly from higher general mortality risk, and partly from COVID-specific risk.

Evidence on COVID-19 Mortality and Disparities Using a Novel Measure, COVID excess mortality percentage: Evidence from Indiana, Wisconsin, and Illinois.

COVID-19 mortality rates increase rapidly with age, are higher among men than women, and vary across racial/ethnic groups, but this is also true for other natural causes of death. Prior research on COVID-19 mortality rates and racial/ethnic disparities in those rates has not considered to what extent disparities reflect COVID-19-specific factors, versus preexisting health differences. This study examines both questions. We study the COVID-19-related increase in mortality risk and racial/ethnic disparities in COVID-19 mortality, and how both vary with age, gender, and time period. We use a novel measure validated in prior work, the COVID Excess Mortality Percentage (CEMP), defined as the COVID-19 mortality rate (Covid-MR), divided by the non-COVID natural mortality rate during the same time period (non-Covid NMR), converted to a percentage. The CEMP denominator uses Non-COVID NMR to adjust COVID-19 mortality risk for underlying population health. The CEMP measure generates insights which differ from those using two common measures-the COVID-MR and the all-cause excess mortality rate. By studying both CEMP and COVID-MRMR, we can separate the effects of background health from Covid-specific factors affecting COVID-19 mortality. We study how CEMP and COVID-MR vary by age, gender, race/ethnicity, and time period, using data on all adult decedents from natural causes in Indiana and Wisconsin over April 2020-June 2022 and Illinois over April 2020-December 2021. CEMP levels for racial and ethnic minority groups can be very high relative to White levels, especially for Hispanics in 2020 and the first-half of 2021. For example, during 2020, CEMP for Hispanics aged 18-59 was 68.9% versus 7.2% for non-Hispanic Whites; a ratio of 9.57:1. CEMP disparities are substantial but less extreme for other demographic groups. Disparities were generally lower after age 60 and declined over our sample period. Differences in socio-economic status and education explain only a small part of these disparities.

Disparities in COVID-19 mortality amongst the immunosuppressed: A systematic review and meta-analysis for enhanced disease surveillance

Effective disease surveillance, including that for COVID-19, is compromised without a standardised method for categorising the immunosuppressed as a clinical risk group. We conducted a systematic review and meta-analysis to evaluate whether excess COVID-associated mortality compared to the immunocompetent could meaningfully subdivide the immunosuppressed. Our study adhered to UK Immunisation against infectious disease (Green Book) criteria for defining and categorising immunosuppression. Using OVID (EMBASE, MEDLINE, Transplant Library, and Global Health), PubMed, and Google Scholar, we examined relevant literature between the entirety of 2020 and 2022. We selected for cohort studies that provided mortality data for immunosuppressed subgroups and immunocompetent comparators. Meta-analyses, grey literature and any original works that failed to provide comparator data or reported all-cause or paediatric outcomes were excluded. Odds Ratios (OR) and 95% confidence intervals (CI) of COVID-19 mortality were meta-analysed by immunosuppressed category and subcategory. Subgroup analyses differentiated estimates by effect measure, country income, study setting, level of adjustment, use of matching and publication year. Study screening, extraction and bias assessment were performed blinded and independently by two researchers; conflicts were resolved with the oversight of a third researcher. PROSPERO registration number is CRD42022360755. We identified 99 unique studies, incorporating data from 1,542,097 and 56,248,181 unique immunosuppressed and immunocompetent patients with COVID-19 infection, respectively. Compared to immunocompetent people (pooled OR, 95%CI), solid organ transplants (2.12, 1.50-2.99) and malignancy (2.02, 1.69-2.42) patients had a very high risk of COVID-19 mortality. Patients with rheumatological conditions (1.28, 1.13-1.45) and HIV (1.20, 1.05-1.36) had just slightly higher risks than the immunocompetent baseline. Case type, setting income and mortality data matching and adjustment were significant modifiers of excess immunosuppressed mortality for some immunosuppressed subgroups. Excess COVID-associated mortality among the immunosuppressed compared to the immunocompetent was seen to vary significantly across subgroups. This novel means of subdivision has prospective benefit for targeting patient triage, shielding and vaccination policies during periods of high disease transmission.

Unequal loss: Disparities in relational closeness to a COVID-19 death among U.S. older adults.

COVID-19 mortality occurred unevenly across U.S. demographic subgroups, leaving some communities harder hit than others. Black and Hispanic/Latino older adults are among those disproportionately affected by COVID-19 mortality, and in turn, COVID-19 bereavement. Because disparities in COVID-19 mortality may extend to COVID-19 bereavement, it is important to understand the incidence of COVID-19 bereavement among older adults at various degrees of relational closeness (e.g., spouse vs. household member vs. friend). We used the National Social Health and Aging Project (NSHAP) COVID Study to evaluate disparities in loss of a social network member to COVID-19 among U.S. older adults by race/ethnicity, language, and relational closeness. Multiple logistic regression was used to estimate the likelihood of experiencing a COVID-19 death in one's social network. None of the English-speaking, non-Hispanic White respondents reported the loss of a household member or spouse to COVID-19. English-speaking, non-Hispanic Black and English-speaking, Hispanic older adults were overrepresented in reporting a death at every degree of relational closeness. However, close COVID-19 bereavement was most prevalent among Spanish-speaking older adults of any race. Although Spanish speakers comprised only 4.8% of the sample, half of the respondents who lost a spouse to COVID-19 were Spanish speakers. Language and ethnoracial group disparities persisted after controlling for age, sex, marital status, and education. Known ethnoracial disparities in COVID-19 mortality extend to COVID-19 bereavement among older adults. Because bereavement impacts health, Black, Latino, and Spanish-speaking communities need greater protection and investment to prevent disparities in bereavement from exacerbating disparities in later-life mental and physical health.

Association of Social Vulnerability and COVID-19 Mortality Rates in Texas between 15 March 2020, and 21 July 2022: An Ecological Analysis.

Despite the key role of social vulnerability such as economic disadvantage in health outcomes, research is limited on the impact of social vulnerabilities on COVID-19-related deaths, especially at the state and county level in the USA. We conducted a cross-sectional ecologic analysis of COVID-19 mortality by the county-level Minority Health Social Vulnerability Index (MH SVI) and each of its components in Texas. Negative binomial regression (NBR) analyses were used to estimate the association between the composite MH SVI (and its components) and COVID-19 mortality. A 0.1-unit increase in the overall MH SVI (IRR, 1.27; 95% CI, 1.04-1.55; p = 0.017) was associated with a 27% increase in the COVID-19 mortality rate. Among the MH SVI component measures, only low socioeconomic status (IRR, 1.55; 95% CI, 1.28-1.89; p = 0.001) and higher household composition (e.g., proportion of older population per county) and disability scores (IRR, 1.47; 95% CI, 1.29-1.68; p < 0.001) were positively associated with COVID-19 mortality rates. This study provides further evidence of disparities in COVID-19 mortality by social vulnerability and can inform decisions on the allocation of social resources and services as a strategy for reducing COVID-19 mortality rates and similar pandemics in the future.

Examining the Relationship between Anti-Black Racism, Community and Police Violence, and COVID-19 Vaccination

In 2020, the COVID-19 pandemic emerged against a backdrop of long-standing racial inequities that contributed to significant disparities in COVID-19 mortality, morbidity, and eventually, vaccination rates. COVID-19 also converged with two social crises: anti-Black racism and community and police violence. The goal of this study was to examine the associations between community violence, police violence, anti-Black racism, and COVID-19 vaccination. Survey data were collected from a sample of 538 Black residents of Chicago between September 2021 and March 2022. Structural equation modeling was used to test associations between neighborhood violence, police violence, racism, medical mistrust, trust in COVID-related information, depressive symptoms, and having received a COVID-19 vaccination. In line with predictions, neighborhood violence had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor. Additionally, racism had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor, as well as via medical mistrust and trust in COVID-related information from a personal doctor. These findings add to the growing body of literature demonstrating the importance of medical mistrust when examining COVID-19 vaccination disparities. Furthermore, this study highlights the importance of considering how social and structural factors such as violence and racism can influence medical mistrust.

COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022

Prior research has established that Hispanic and non-Hispanic Black residents in the US experienced substantially higher COVID-19 mortality rates in 2020 than non-Hispanic White residents owing to structural racism. In 2021, these disparities decreased. To assess to what extent national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and subsequent Omicron wave reflect reductions in mortality vs other factors, such as the pandemic's changing geography. This cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, among adults aged 25 years and older residing in the US. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between initial and Omicron waves was decomposed. Data were analyzed from June 2021 through March 2023. Metropolitan vs nonmetropolitan areas and race and ethnicity. Age-standardized death rates. There were death certificates for 977 018 US adults aged 25 years and older (mean [SD] age, 73.6 [14.6] years; 435 943 female [44.6%]; 156 948 Hispanic [16.1%], 140 513 non-Hispanic Black [14.4%], and 629 578 non-Hispanic White [64.4%]) that included a mention of COVID-19. The proportion of COVID-19 deaths among adults residing in nonmetropolitan areas increased from 5944 of 110 526 deaths (5.4%) during the initial wave to a peak of 40 360 of 172 515 deaths (23.4%) during the Delta wave; the proportion was 45 183 of 210 554 deaths (21.5%) during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100 000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased from 339 to 45 deaths from the initial to Omicron wave, or by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 120 deaths/100 000 person-years of the decrease (40.7%); 58 deaths/100 000 person-years in the decrease (19.6%) were explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults reside. The remaining 116 deaths/100 000 person-years in the decrease (39.6%) were explained by decreases in death rates in non-Hispanic Black adults. This study found that most of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic spread of the pandemic. These findings suggest that despite media reports of a decline in disparities, there is a continued need to prioritize racial health equity in the pandemic response.

Ethnic/Racial Disparity in Mortality from COVID-19: Data for the Year 2020 in Brazil.

The study aimed to investigate ethnic/racial disparities in COVID-19 mortality in Brazilian federative units and their respective capitals in 2020. Population data and number of COVID-19 deaths were extracted by skin color (white, black, brown and indigenous) from all Brazilian states and their respective capitals. The mortality rate of COVID-19 by ethnicity in Brazilian states was higher between people from brown skin color, followed by indigenous and black. Only in one state, in the Federal District and in the federal capital, age-standardized mortality rates were higher among white's people. There is a high percentage of deaths from COVID-19 higher than expected among non-white individuals, especially in south-central states and capitals of the country. Mortality from COVID-19 affect ethnic-racial groups unevenly in Brazil and the number of excess deaths among non-whites was over 9000. Urgent government measures are needed to reduce the racial disparity in health indicators in Brazil.

Racial/Ethnic Disparities in COVID-19 Mortality: National Evidence from Death Certificates

Racial/Ethnic Disparities in COVID-19 Mortality: National Evidence from Death Certificates

Online Appendix for Racial/Ethnic Disparities in COVID-19 Mortality: National Evidence from Death Certificates

Online Appendix for Racial/Ethnic Disparities in COVID-19 Mortality: National Evidence from Death Certificates

Pandemic Meets Endemic: The Role of Social Inequalities and Failing Public Health Policies as Drivers of Disparities in COVID-19 Mortality among White, Black, and Hispanic Communities in the United States of America.

The COVID-19 pandemic placed the United States of America (U.S.) under enormous strain, leaving it with higher deaths during the first wave of the outbreak compared to all other advanced economies. Blacks and Hispanics were among those hardest hit by the virus-a fact attributed to enduring problems related to the social determinants of health adversely affecting Communities of Color (CoC). In this study, we ask which distinct factors relating to policy stringency and community vulnerability influenced COVID-19 mortality among Whites, Blacks, and Hispanics during the first year of the pandemic. To address this question, we utilized a mix of correlational and regression analyses. Findings point to the highly divergent impact of public policy and vulnerability on COVID-19 mortality. Specifically, we observed that state-led measures aimed at controlling the spread of the virus only improved mortality for Whites. However, pre-existing social determinants of health (i.e., population density, epidemiological and healthcare system factors) played a significant role in determining COVID-19 outcomes for CoC, even in the face of stringent containment measures by states. This suggests that state-led policy to address present and/or future public health crises need to account for the particular nature of vulnerability affecting Blacks and Hispanics in the U.S.

PSUN148 Disparities in COVID-19 Mortality in Hispanic and Non-Hispanic Patients with Metabolic Syndrome in a Community-Based Hospital

Abstract In Hispanic populations, rates of metabolic comorbidities such as obesity are higher than that of non-Hispanic White in the United States. Despite having higher comorbidity rates, Hispanic populations have a lower total risk of mortality compared to non-Hispanic counterparts. In this study, we explore whether this paradox exists for COVID-19 related deaths in Hispanic patients with Metabolic Syndrome (MetS). MetS is defined by the WHO as having at least 3 of the following 5 criteria: obesity, hypertension, diabetes, hypertriglyceridemia, and low levels of HDL. A retrospective study was conducted of patients hospitalized for COVID-19 between January 1, 2020 and May 1, 2021 at a regional county hospital in Southern California. In this cohort of 269 patients, 55.4% were male, mean age was 58.4 (IQR, 48-68) years, 63.9% had obesity, 42.4% had hypertension, 40.1% had diabetes, 18.2% had hypertriglyceridemia, and 32.3% had low HDL levels, and 30.9% fit the criteria for MetS. The racial demographic of this cohort was 78.8% Hispanic, 6.32% African American, 4.46% White and 3.72% Asian. Odds ratios and confidence intervals for the relationship between MetS and mortality were calculated separately among patients who were either Hispanic or non-Hispanic. Multivariable logistic regressions accounting for interactions between MetS and Hispanic patients were assessed. In our cohort, 49 (18.2%) patients died of COVID-19. Hispanic patients had a lower probability of mortality (16.0%; 95% CI 11.1-21.0) than non-Hispanic patients (26.3%; 95% Cl 14.9-37.7). Hispanic patients with MetS had a higher risk of mortality from COVID-19 ([OR] 1.57; 95% Cl 0.74-3.33) compared to Hispanic patients without MetS. Non-Hispanic patients with MetS also had a higher risk of mortality from COVID-19 ([OR] 4.38; 95% Cl 1.19-16.03) compared to non-Hispanic patients without MetS. The MetS effect on mortality in Hispanic was 64% lower than that in non-Hispanic patients, although this result did not reach statistical significance (p value=0.18.) Our data suggests that MetS is a risk factor for COVID-19 mortality and MetS may have a lower impact on COVID-19 related death in the Hispanic population than non-Hispanic counterparts. Studies with larger sample sizes will be required to confirm these relationships. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

How Cumulative Statistics Can Mislead: The Temporal Dynamism of Sex Disparities in COVID-19 Mortality in New York State.

Overall, men have died from COVID-19 at slightly higher rates than women. But cumulative estimates of mortality by sex may be misleading. We analyze New York State COVID-19 mortality by sex between March 2020 and August 2021, demonstrating that 72.7% of the total difference in the number of COVID-19 deaths between women and men was accrued in the first seven weeks of the pandemic. Thus, while the initial surge in COVID-19 mortality was characterized by stark sex disparities, this article shows that disparities were greatly attenuated in subsequent phases of the pandemic. Investigating changes over time could help illuminate how contextual factors contributed to the development of apparent sex disparities in COVID-19 outcomes.

Ethnic differences in COVID-19 mortality in the second and third waves of the pandemic in England during the vaccine roll-out.

ObjectivesThis study aims to assess whether ethnic differences in COVID-19 mortality in England have continued into the third wave and to what extent differences in vaccination rates contributed to excess COVID-19 mortality after accounting for other risk factors. &#x0D; ApproachThis Cohort study of 28.8 million adults living in private households or communal establishments in England is based on data from the Office for National Statistics (ONS) Public Health Data Asset (PHDA). The ONS PHDA is a linked dataset combining the 2011 Census, mortality records, the General Practice Extraction Service (GPES) Data for Pandemic Planning and Research (GDPPR), Hospital Episode Statistics (HES) and vaccination data from the National Immunisation Management System (NIMS). We calculated hazard ratios (HRs) for death involving COVID-19 during the second (8 December 2020 to 12 June 2021) and third wave (13 June 2021 to 1 December 2021) of the pandemic separately for males to females to assess the association between ethnic group and death involving COVID-19 in each wave, sequentially adjusting for age, residence type, geographical factors, sociodemographic characteristics, pre-pandemic health, and vaccination status.&#x0D; ResultsAge-adjusted HRs of death involving COVID-19 were higher for most ethnic minority groups than the White British group during both waves, particularly for groups with lowest vaccination rates (Bangladeshi, Pakistani, Black African and Black Caribbean). In both waves, HRs were attenuated after adjusting for geographical factors, sociodemographic characteristics, and pre-pandemic health. Further adjusting for vaccination status substantially reduced residual HRs for Black African, Black Caribbean, and Pakistani groups in the third wave. The only groups where fully-adjusted HRs remained elevated were the Bangladeshi group (men: 2.19, 95% CI 1.72 to 2.78; women: 2.12, 95% CI 1.58 to 2.86) and men from the Pakistani group (1.24, 95% CI 1.06 to 1.46). &#x0D; ConclusionPublic health strategies to increase vaccination uptake in ethnic minority groups could reduce disparities in COVID-19 mortality that cannot be accounted for by pre-existing risk factors.

Americans' perceptions of health disparities over the first year of the COVID-19 pandemic: Results from three nationally-representative surveys

COVID-19 has illuminated health inequity in the United States. The burdens of disease are much higher among Black and Indigenous people and other people of color. Disparities by income are also profound, as lower-wage workers were less able to adopt mitigating behaviors compared to higher-income counterparts. These disparities became part of public health discourse in 2020, with commentators frequently highlighting the connection between racism, socioeconomic position, and COVID-19. But what proportion of the public—and among key subgroups—recognized these social group disparities, relative to disparities associated with age and chronic illness, and did public recognition change over the first year of the pandemic? To address these questions, we analyzed data from three nationally-representative cross-sectional public opinion surveys, collected using the NORC AmeriSpeak panel in April 2020 (N = 1007), August 2020 (N = 2716), and April 2021 (N = 1020). The key outcomes were respondents' agreement with statements about disparities in COVID-19 mortality by age, chronic illness, income, and race. We found little change from 2020 to 2021 in Americans' recognition of disparities. At all three time points, most respondents acknowledged age and chronic illness disparities, while no more than half at any time point recognized income- and race-based disparities. Political party affiliation was not statistically associated with agreement with age or illness-related disparities, but was strongly associated with views about income- and race-based disparities. Efforts to promote recognition of racial and socioeconomic health disparities in the United States need to be mindful of the ways in which public understanding of health inequities is linked to partisanship.

Joint Effects of Socioeconomic Position, Race/Ethnicity, and Gender on COVID-19 Mortality among Working-Age Adults in the United States.

Substantial racial/ethnic and gender disparities in COVID-19 mortality have been previously documented. However, few studies have investigated the impact of individual socioeconomic position (SEP) on these disparities. Objectives: To determine the joint effects of SEP, race/ethnicity, and gender on the burden of COVID-19 mortality. A secondary objective was to determine whether differences in opportunities for remote work were correlated with COVID-19 death rates for sociodemographic groups. Design: Annual mortality study which used a special government tabulation of 2020 COVID-19-related deaths stratified by decedents’ SEP (measured by educational attainment), gender, and race/ethnicity. Setting: United States in 2020. Participants: COVID-19 decedents aged 25 to 64 years old (n = 69,001). Exposures: Socioeconomic position (low, intermediate, and high), race/ethnicity (Hispanic, Black, Asian, Indigenous, multiracial, and non-Hispanic white), and gender (women and men). Detailed census data on occupations held by adults in 2020 in each of the 36 sociodemographic groups studied were used to quantify the possibility of remote work for each group. Main Outcomes and Measures: Age-adjusted COVID-19 death rates for 36 sociodemographic groups. Disparities were quantified by relative risks and 95% confidence intervals. High-SEP adults were the (low-risk) referent group for all relative risk calculations. Results: A higher proportion of Hispanics, Blacks, and Indigenous people were in a low SEP in 2020, compared with whites. COVID-19 mortality was five times higher for low vs. high-SEP adults (72.2 vs. 14.6 deaths per 100,000, RR = 4.94, 95% CI 4.82–5.05). The joint detriments of low SEP, Hispanic ethnicity, and male gender resulted in a COVID-19 death rate which was over 27 times higher (178.0 vs. 6.5 deaths/100,000, RR = 27.4, 95% CI 25.9–28.9) for low-SEP Hispanic men vs. high-SEP white women. In regression modeling, percent of the labor force in never remote jobs explained 72% of the variance in COVID-19 death rates. Conclusions and Relevance: SARS-CoV-2 infection control efforts should prioritize low-SEP adults (i.e., the working class), particularly the majority with “never remote” jobs characterized by inflexible and unsafe working conditions (i.e., blue collar, service, and retail sales workers).