Assessing differential impacts of COVID-19 on black communities
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Abstract
Purpose: Given incomplete data reporting by race, we used data on COVID-19 cases and deaths in U.S. counties to describe racial disparities in COVID-19 disease and death and associated determinants. Methods: Using publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (≥13%) black and all other (<13% black) counties. Rate ratios were calculated, and population attributable fractions were estimated using COVID-19 cases and deaths via zero-inflated negative binomial regression model. National maps with county-level data and an interactive scatterplot of COVID-19 cases were generated. Results: Nearly 90% of disproportionately black counties (656/677) reported a case and 49% (330/677) reported a death versus 81% (1987/2465) and 28% (684/2465), respectively, for all other counties. Counties with higher proportions of black people have higher prevalence of comorbidities and greater air pollution. Counties with higher proportions of black residents had more COVID-19 diagnoses (Rate Ratio (RR): 1.24, 95% confidence interval: 1.17-1.33) and deaths (RR: 1.18, 95% confidence interval: 1.00-1.40), after adjusting for county-level characteristics such as age, poverty, comorbidities, and epidemic duration. COVID-19 deaths were higher in disproportionally black rural and small metro counties. The population attributable fraction of COVID-19 diagnosis due to lack of health insurance was 3.3% for counties with less than 13% black residents and 4.2% for counties with greater than or equal to 13% black residents. Conclusions: Nearly 20% of U.S. counties are disproportionately black, and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally. County-level comparisons can both inform COVID-19 responses and identify epidemic hot spots. Social conditions, structural racism, and other factors elevate risk for COVID-19 diagnoses and deaths in black communities.
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Because evidence suggests that poverty-associated factors are associated with significantly higher numbers of COVID-19 cases and deaths than are comorbidities, net variations in fertility rates associated with these factors would lead towards underestimation of global minimum estimates for orphanhood.
“Additionally, because evidence suggests that poverty-associated factors are associated with significantly higher numbers of COVID-19 cases and deaths than are comorbidities, it is likely that net variations in fertility rates associated with these factors (ie, higher rates associated with poverty and lower rates with comorbidities) would lead towards underestimation of global minimum estimates for”
From Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study (2021) · cites this paper as [40]
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Experimental — accuracy not yet measuredThe PEPFAR DREAMS programme has prevented such outcomes for millions of adolescent and pre-adolescent girls-including many orphans-through evidence-based interventions combining positive parenting, norms change, economic strengthening, education, life-skills programmes, and clinical services for victims.
“The PEPFAR DREAMS programme has prevented such outcomes for millions of adolescent and pre-adolescent girls—including many orphans—through evidence-based interventions combining positive parenting, norms change, economic strengthening, education, life-skills programmes, and clinical services for victims.34”
From Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study (2021) · cites this paper as [34]
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- Authors
- Millett, G. A., Jones, A. T., Benkeser, D., Baral, S., Mercer, L., Beyrer, C., Honermann, B., Lankiewicz, E., Mena, L., Crowley, J. S., Sherwood, J., & Sullivan, P. S.
- Affiliations
- American Foundation for AIDS Research (US)
- Emory University (US)
- Johns Hopkins University (US)
- Program for Appropriate Technology in Health (US)
- University of Mississippi Medical Center (US)
- Georgetown University (US)
- Corresponding author
- Millett, Gregorio A.
- ORCID
- Venue
- Annals of Epidemiology
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 47
- Pages
- 37-44
- ISSN
- 1047-2797 (ISSN-L)
- PMC
- PMC7224670
- OpenAlex
- W3024397965
- Cited by
- 1,217
- References
- 1
- Citations by year
- 2026: 32 · 2025: 43 · 2024: 85 · 2023: 174 · 2022: 283 · 2021: 395 · 2020: 203
- FWCI
- 41.93
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Annals of Epidemiology (publishedVersion, cc-by-nc-nd)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- amfAR, The Foundation for AIDS Research
- 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, racial disparities, Black communities, structural racism, health disparities, COVID-19 mortality, COVID-19 incidence, county-level disparities, health insurance, comorbidities, air pollution, rural counties, population attributable fraction, zero-inflated negative binomial regression
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Black or African American, Humans, Pneumonia, Viral, Rural Population, Coronavirus, Coronavirus Infections, Health Status Disparities, Pandemics
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