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. 2020 Dec:189:129-134.
doi: 10.1016/j.puhe.2020.09.016. Epub 2020 Oct 17.

Socio-economic status and COVID-19-related cases and fatalities

R B Hawkins  1 , E J Charles  2 , J H Mehaffey  2
Affiliations

Socio-economic status and COVID-19-related cases and fatalities

R B Hawkins et al. Public Health. 2020 Dec.

Abstract

Objectives: The United States has the highest number of coronavirus disease 2019 (COVID-19) in the world, with high variability in cases and mortality between communities. We aimed to quantify the associations between socio-economic status and COVID-19-related cases and mortality in the U.S.

Study design: The study design includes nationwide COVID-19 data at the county level that were paired with the Distressed Communities Index (DCI) and its component metrics of socio-economic status.

Methods: Severely distressed communities were classified by DCI>75 for univariate analyses. Adjusted rate ratios were calculated for cases and fatalities per 100,000 persons using hierarchical linear mixed models.

Results: This cohort included 1,089,999 cases and 62,298 deaths in 3127 counties for a case fatality rate of 5.7%. Severely distressed counties had significantly fewer deaths from COVID-19 but higher number of deaths per 100,000 persons. In risk-adjusted analysis, the two socio-economic determinants of health with the strongest association with both higher cases per 100,000 persons and higher fatalities per 100,000 persons were the percentage of adults without a high school degree (cases: RR 1.10; fatalities: RR 1.08) and proportion of black residents (cases and fatalities: Relative risk(RR) 1.03). The percentage of the population aged older than 65 years was also highly predictive for fatalities per 100,000 persons (RR 1.07).

Conclusion: Lower education levels and greater percentages of black residents are strongly associated with higher rates of both COVID-19 cases and fatalities. Socio-economic factors should be considered when implementing public health interventions to ameliorate the disparities in the impact of COVID-19 on distressed communities.

Keywords: COVID-19; Coronavirus; Race; SARS-CoV-2; Socio-economic status.

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Figures

Fig. 1
Fig. 1
Consort diagram of included and excluded counties, COVID-19 cases, and COVID-19 fatalities. COVID-19 = coronavirus disease 2019.
Fig. 2
Fig. 2
Forrest plot of adjusted rate ratio for covariates significantly associated with either COVID-19 cases or fatalities per 100,000 persons. COVID-19 = coronavirus disease 2019.
Fig. 3
Fig. 3
Adjusted predicted COVID-19 cases per 100,000 persons for the two strongest socio-economic factors. (A) Percentage of adults without a high school degree and (B) percentage of population Black. Estimates are shown holding all other predictors at mean values (Supplemental Table 1). COVID-19 = coronavirus disease 2019.
Fig. 4
Fig. 4
Adjusted predicted COVID-19 fatalities per 100,000 persons for the three strongest socio-economic factors. (A) Percentage of adults without a high school degree and (B) percentage of population Black. Estimates are shown holding all other predictors at mean values (Supplemental Table 1). COVID-19 = coronavirus disease 2019.
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