Community-Level Factors Associated With Racial And Ethnic Disparities In COVID-19 Rates In Massachusetts

Abstract

Massachusetts has one of the highest cumulative incidence rates of coronavirus disease 2019 (COVID-19) cases in the US. Understanding which specific demographic, economic, and occupational factors have contributed to disparities in COVID-19 incidence rates across the state is critical to informing public health strategies. We performed a cross-sectional study of 351 Massachusetts cities and towns from January 1 to May 6, 2020, and found that a 10-percentage-point increase in the Black non-Latino population was associated with an increase of 312.3 COVID-19 cases per 100,000 population, whereas a 10-percentage-point increase in the Latino population was associated with an increase of 258.2 cases per 100,000. Independent predictors of higher COVID-19 rates included the proportion of foreign-born noncitizens living in a community, mean household size, and share of food service workers. After adjustment for these variables, the association between the Latino population and COVID-19 rates was attenuated. In contrast, the association between the Black population and COVID-19 rates persisted but may be explained by other systemic inequities. Public health and policy efforts that improve care for foreign-born noncitizens, address crowded housing, and protect food service workers may help mitigate the spread of COVID-19 among minority communities.

Appendix Exhibit 3.

Proportion Black Population and Number of COVID-19 Cases and Deaths per 100,000 Population Across Massachusetts Counties Source: Authors’ analyses of Massachusetts Department of Public Health Data 2020 and American Community Survey Caption: Massachusetts counties include: Barnstable, Berkshire, Bristol, Dukes, Essex, Franklin, Hampden, Hampshire, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, Worchester. Size of data points correspond to the relative county population sizes. Data from January 1^st to May 6^th, 2020 from Massachusetts Department of Public Health. ^a Pearson Correlation Coefficient, 0.72 (p-value = 0.004) ^b Pearson Correlation Coefficient, 0.45 (p-value = 0.02)

Appendix Exhibit 4.

Proportion Latino Population and Number of COVID-19 Cases and Deaths per 100,000 Population Across Massachusetts Counties Source: Authors’ analyses of Massachusetts Department of Public Health Data 2020 and American Community Survey Notes: Counties include: Barnstable, Berkshire, Bristol, Dukes, Essex, Franklin, Hampden, Hampshire, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, Worchester. Size of data points correspond to the relative county population sizes. Data from January 1^st to May 6^th, 2020 from Massachusetts Department of Public Health. ^a Pearson Correlation Coefficient, 0.69 (p-value=0.006) ^b Pearson Correlation Coefficient, 0.61 (p-value=0.020)

Appendix Exhibit 5.

Number of COVID-19 Cases per 100,000 Population and Number of COVID-19 Deaths per 100,000 Population Across Massachusetts Counties^a Source: Authors’ analyses of Massachusetts Department of Public Health Data 2020 and American Community Survey Notes: Massachusetts counties include: Barnstable, Berkshire, Bristol, Dukes, Essex, Franklin, Hampden, Hampshire, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, Worchester. Size of data points correspond to the relative county population sizes. Data from January 1^st to May 6^th, 2020 from Massachusetts Department of Public Health. ^aPearson Correlation Coefficient for COVID-19 Case Rates and Death Rates = 0.82 (p<0.001)