County-level socio-economic disparities in COVID-19 mortality in the USA

Background Preliminary studies have suggested a link between socio-economic characteristics and COVID-19 mortality. Such studies have been carried out on particular geographies within the USA or selective data that do not represent the complete experience for 2020. Methods We estimated COVID-19 mortality rates, number of years of life lost to SARS-CoV-2 and reduction in life expectancy during each of the three pandemic waves in 2020 for 3144 US counties grouped into five socio-economic status categories, using daily death data from the Johns Hopkins University of Medicine and weekly mortality age structure from the Centers for Disease Control. Results During March-May 2020, COVID-19 mortality was highest in the most socio-economically advantaged quintile of counties and lowest in the two most-disadvantaged quintiles. The pattern reversed during June-August and widened by September-December, such that COVID-19 mortality rates were 2.58 times higher in the bottom than in the top quintile of counties. Differences in the number of years of life lost followed a similar pattern, ultimately resulting in 1.002 (1.000, 1.004) million years in the middle quintile to 1.381 (1.378, 1.384) million years of life lost in the first (most-disadvantaged) quintile during the whole year. Conclusions Diverging trajectories of COVID-19 mortality among the poor and affluent counties indicated a progressively higher rate of loss of life among socio-economically disadvantaged communities. Accounting for socio-economic disparities when allocating resources to control the spread of the infection and to reinforce local public health infrastructure would reduce inequities in the mortality burden of the disease.

Automated summary

A study found a link between socio-economic characteristics and COVID-19 mortality rates in US counties. The study revealed that during the pandemic waves in 2020, COVID-19 mortality rates were higher in socio-economically advantaged counties, but reversed and widened by September-December, with higher rates in socio-economically disadvantaged counties. The study suggests that addressing socio-economic disparities can reduce the inequities in COVID-19 mortality burden.