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

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 (beta > 0, p<0.05 for all relations). A higher proportion of the Hispanic population was associated with higher confirmed cases (beta = 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.

Automated summary

In the United States, counties with a higher proportion of Black population and adults with less than a high school diploma had disproportionately higher COVID-19 cases and deaths. A higher proportion of Hispanic population was associated with higher confirmed cases. Despite adjusting for covariates, observed disparities in COVID-19 deaths persisted, potentially exacerbating existing health disparities among these population groups.