4.5 Article

Racial/Ethnic Disparities In COVID-19 Exposure Risk, Testing, And Cases At The Subcounty Level In California

Journal

HEALTH AFFAIRS
Volume 40, Issue 6, Pages 870-878

Publisher

PROJECT HOPE
DOI: 10.1377/hlthaff.2021.00098

Keywords

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Funding

  1. State of California [184726]
  2. Stanford's Knight-Hennessy Scholars program
  3. Stanford Interdisciplinary Graduate Fellowship
  4. Stanford Clinical and Translational Science Award [UL1TR003142]
  5. Centers for Disease Control and Prevention though the Council of State and Territorial Epidemiologists [NU38OT000297-02]
  6. National Institute on Drug Abuse [3R37DA01561217S1]

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Research in California has shown that Latino populations are more likely than other racial/ethnic minorities to live in high-exposure-risk households, have higher cumulative cases, and lower testing rates. Subcounty disparity analyses can help inform targeted interventions, such as community testing and vaccine access measures, to address these disparities.
With a population of forty million and substantial geographic variation in sociodemographics and health services, California is an important setting in which to study disparities. Its population (37.5 percent White, 39.1 percent Latino, 5.3 percent Black, and 14.4 percent Asian) experienced 59,258 COVID-19 deaths through April 14, 2021-the most of any state. We analyzed California's racial/ethnic disparities in COVID-19 exposure risks, testing rates, test positivity, and case rates through October 2020, combining data from 15.4 million SARS-CoV-2 tests with subcounty exposure risk estimates from the American Community Survey. We defined high-exposure-risk households as those with one or more essential workers and fewer rooms than inhabitants. Latino people in California are 8.1 times more likely to live in high-exposure-risk households than White people (23.6 percent versus 2.9 percent), are overrepresented in cumulative cases (3,784 versus 1,112 per 100,000 people), and are underrepresented in cumulative testing (35,635 versus 48,930 per 100,000 people). These risks and outcomes were worse for Latino people than for members of other racial/ethnic minority groups. Subcounty disparity analyses can inform targeting of interventions and resources, including community-based testing and vaccine access measures. Tracking COVID-19 disparities and developing equity-focused public health programming that mitigates the effects of systemic racism can help improve health outcomes among California's populations of color.

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