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Comparative Study
. 2021 Jan/Feb:27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward:S43-S56.
doi: 10.1097/PHH.0000000000001263.

Revealing the Unequal Burden of COVID-19 by Income, Race/Ethnicity, and Household Crowding: US County Versus Zip Code Analyses

Jarvis T Chen  1 , Nancy Krieger
Affiliations
Comparative Study

Revealing the Unequal Burden of COVID-19 by Income, Race/Ethnicity, and Household Crowding: US County Versus Zip Code Analyses

Jarvis T Chen et al. J Public Health Manag Pract. 2021 Jan/Feb.

Abstract

Objective: To overcome the absence of national, state, and local public health data on the unequal economic and social burden of COVID-19 in the United States.

Design: We analyze US county COVID-19 deaths and confirmed COVID-19 cases and positive COVID-19 tests in Illinois and New York City zip codes by area percent poverty, percent crowding, percent population of color, and the Index of Concentration at the Extremes.

Setting: US counties and zip codes in Illinois and New York City, as of May 5, 2020.

Main outcome measures: Rates, rate differences, and rate ratios of COVID-19 mortality, confirmed cases, and positive tests by category of county and zip code-level area-based socioeconomic measures.

Results: As of May 5, 2020, the COVID-19 death rate per 100 000 person-years equaled the following: 143.2 (95% confidence interval [CI]: 140.9, 145.5) vs 83.3 (95% CI: 78.3, 88.4) in high versus low poverty counties (≥20% vs <5% of persons below poverty); 124.4 (95% CI: 122.7, 126.0) versus 48.2 (95% CI: 47.2, 49.2) in counties in the top versus bottom quintile for household crowding; and 127.7 (95% CI: 126.0, 129.4) versus 25.9 (95% CI: 25.1, 26.6) for counties in the top versus bottom quintile for the percentage of persons who are people of color. Socioeconomic gradients in Illinois confirmed cases and New York City positive tests by zip code-level area-based socioeconomic measures were also observed.

Conclusions: Stark social inequities exist in the United States for COVID-19 outcomes. We recommend that public health departments use these straightforward cost-effective methods to report on social inequities in COVID-19 outcomes to provide an evidence base for policy and resource allocation.

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References

    1. Krieger N, Gonsalves G, Bassett MT, Hanage W, Krumholz HM. The fierce urgency of now: closing glaring gaps in US surveillance data on COVID-19. Health Aff Blog. https://www.healthaffairs.org/do/10.1377/hblog20200414.238084/full . Published April 14, 2020. Accessed May 6, 2020.
    1. Krieger N. COVID-19, data, and health justice. To The Point. https://www.commonwealthfund.org/blog/2020/covid-19-data-and-health-justice . Published April 16, 2020. Accessed May 6, 2020.
    1. Kendi IX, What the racial data show. The Atlantic. April 6, 2020. https://www.theatlantic.com/ideas/archive/2020/04/coronavirus-exposing-o... . Accessed May 6, 2020.
    1. The COVID Tracking Project. About the data. https://covidtracking.com/about-data . Accessed May 6, 2020.
    1. US Centers for Disease Control and Prevention. Cases of coronavirus (COVID-19) in the US. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html . Accessed May 6, 2020.

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