The Unequal Burden of COVID-19 Deaths in Counties With High Proportions of Black and Hispanic Residents

摘要

Supplemental Digital Content is available in the text. Background: Understanding the current burden of coronavirus disease 2019 (COVID-19) deaths in vulnerable populations will help inform efforts by policymakers to address disparities in COVID-19 outcomes. Objective: The objective of this study was to examine the association between COVID-19 deaths and the county-level proportions of non-Hispanic Black and Hispanic residents. Research Design and Methods: A retrospective study using COVID-19 mortality data from USA Facts linked to data from the US Census Bureau, the Health Resources & Services Administration Area Health Resources file, and the US Census Bureau. Negative binomial regression was used to estimate the association between the total county COVID-19 deaths during consecutive 30-day intervals and the proportion of non-Hispanic Blacks and Hispanic residents after adjusting for resident demographics, comorbidity burden, rurality, social determinants of health, and health care resources. Results: In April, counties (n=179) with >40% Blacks had 6-fold higher death rates than counties (n=1521) with <2% Blacks [incident rate ratio (IRR)=6.58, 95% confidence interval (CI): 3.29–13.2, P 40% Hispanic residents were similar to death rates in counties with <2% Hispanic residents. Death rates in these counties peaked in August (IRR=3.14, 95% CI: 1.69–5.82, P 15% uninsurance rates had up to 2-fold higher mortality rates (IRR=1.97, 95% CI: 1.19–3.27, P <0.001) than counties with <5% uninsurance rates. Conclusion: Counties with high concentrations of non-Hispanic Blacks were disproportionately affected by COVID-19 throughout most of the pandemic, but other social determinants of health such as health insurance are now playing a more prominent role than race and ethnicity.