Association Between County-Level Racial and Ethnic Characteristics and COVID-19 Cases and Deaths in the USA

Excerpt

Coronavirus disease 2019 (COVID-19) has resulted in over 1.5 million infections and 100,000 deaths in the USA. Early reports indicated that communities with high proportions of racial and ethnic minorities may be disproportionately affected. However, existing evidence is limited to studies that examined simple correlations without adjustments for potential confounders¹ or compared counties in a single state (Massachusetts).² Another recent study sought to answer this question by using national county-level data, but compared counties with disproportionately high numbers of Black residents—which are predominantly (91%) located in the South—versus counties with a lower proportion of Black residents across states. Therefore, the study effectively compared the South versus other regions of the USA.³ More importantly, states vary substantially in their responses to the COVID-19 pandemic; therefore, not accounting for state characteristics may lead to biased estimates of the relationship between the proportion of Black residents and the impact of COVID-19 outbreaks. …