Association of Social and Demographic Factors with COVID-19 Incidence and Death Rates in the US
Open accessAbstract
Importance: Descriptive data have revealed significant racial/ethnic disparities in coronavirus disease 2019 (COVID-19) cases in the US, but underlying mechanisms of disparities remain unknown. Objective: To examine the association between county-level sociodemographic risk factors and US COVID-19 incidence and mortality. Design, Setting, and Participants: This cross-sectional study analyzed the association between US county-level sociodemographic risk factors and COVID-19 incidence using mixed-effects negative binomial regression, and COVID-19 mortality using zero-inflated negative binomial regression. Data on COVID-19 incidence and mortality were collected from January 20 to July 29, 2020. The association of social risk factors with weekly cumulative incidence and mortality was also examined by interacting time with the index measures, using a random intercept to account for repeated measures. Main Outcomes and Measures: Sociodemographic data from publicly available data sets, including the US Centers for Disease Control and Prevention's Social Vulnerability Index (SVI), which includes subindices of socioeconomic status, household composition and disability, racial/ethnic minority and English language proficiency status, and housing and transportation. Results: As of July 29, 2020, there were a total of 4 289 283 COVID-19 cases and 147 074 COVID-19 deaths in the US. An increase of 0.1 point in SVI score was associated with a 14.3% increase in incidence rate (incidence rate ratio [IRR], 1.14; 95% CI, 1.13-1.16; P < .001) and 13.7% increase in mortality rate (IRR, 1.14; 95% CI, 1.12-1.16; P < .001), or an excess of 87 COVID-19 cases and 3 COVID-19 deaths per 100 000 population for a SVI score change from 0.5 to 0.6 in a midsize metropolitan county; subindices were also associated with both outcomes. A 0.1-point increase in the overall SVI was associated with a 0.9% increase in weekly cumulative increase in incidence rate (IRR, 1.01; 95% CI, 1.01-1.01; P < .001) and 0.5% increase in mortality rate (IRR, 1.01; 95% CI, 1.01-1.01; P < .001). Conclusions and Relevance: In this cross-sectional study, a wide range of sociodemographic risk factors, including socioeconomic status, racial/ethnic minority status, household composition, and environmental factors, were significantly associated with COVID-19 incidence and mortality. To address inequities in the burden of the COVID-19 pandemic, these social vulnerabilities and their root causes must be addressed.
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Each demographic group showed a different impact of the pandemic based on economic, social, professional, family, and routine aspects.
“Although those dispositional and behavioral dimensions were shared by the entire population, each demographic group showed a different impact of the pandemic based on economic, social, professional, family, and routine aspects [30,31,32,33,34,35].”
From Impact of Stress during COVID-19 Pandemic in Italy: A Study on Dispositional and Behavioral Dimensions for Supporting Evidence-Based Targeted Strategies (2024) · cites this paper as [33]
The Results (page not provided) associate county socioeconomic and household characteristics with differing COVID-19 incidence and mortality, supporting a narrower claim of unequal health outcomes. The Policy Implications section discusses economic effects, but the paper does not show that each demographic group experienced distinct professional, family, and routine impacts; its analysis is county-level and focused on incidence and mortality. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSocial inequalities in COVID-19 deaths were evident during the early pandemic period across the world.
“Social inequalities in COVID-19 deaths were evident during the early pandemic period across the world(2-8).”
From Social inequalities in COVID-19 death by area-level income in 11.2 million people in Ontario, Canada: patterns over time and the mediating role of vaccination. (2026) · cites this paper as [5]
The Introduction reports higher COVID-19 mortality among several racial and ethnic groups and describes disparities in early US outbreaks. The Conclusions also identify social factors associated with COVID-19 mortality in the US. The paper supports the claim for the US, but not its worldwide scope. (LLM, conf=0.88)
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References 26 · Cited by 580
Research works printed but not linked: 1
- [28]Rothman J, Eidelberg D, Rothman S, Holford T, Rothman DL Analysis of the time and age dependence of the case-fatality-ratio for COVID-19 in seven countries with a high total-to-positive test ratio suggests that the true CFR may be significantly underestimated for the United States in current models. medRxiv. Preprint posted online May 23, 2020. doi: 10.1101/2020.05.13.20101022 · DOI
- Authors
- Karmakar, M., Lantz, P. M., & Tipirneni, R.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Tipirneni, Renuka
- ORCID
- Tipirneni, Renuka
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2021-01-29
- Volume
- 4
- Issue
- 1
- Pages
- e2036462
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC7846939
- OpenAlex
- W3121159199
- Cited by
- 580
- References
- 26
- Citations by year
- 2026: 30 · 2025: 52 · 2024: 69 · 2023: 120 · 2022: 181 · 2021: 125 · 2020: 1 · 2014: 1
- FWCI
- 47.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 pandemic, sociodemographic risk factors, Social Vulnerability Index, racial and ethnic disparities, COVID-19 incidence, COVID-19 mortality, socioeconomic status, housing and transportation, English proficiency, county-level disparities, social determinants of health, United States counties, zero-inflated negative binomial regression
- MeSH terms
- COVID-19, SARS-CoV-2, Cross-Sectional Studies, Female, Humans, Male, Risk Factors, Social Class, United States, Incidence, Vulnerable Populations, Health Status Disparities, Pandemics
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