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. 2022 Jun;9(3):886-898.
doi: 10.1007/s40615-021-01028-1. Epub 2021 Apr 27.

Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 35 US States and Their Association with Structural Racism

Michael Siegel  1 , Isabella Critchfield-Jain  2 , Matthew Boykin  2 , Alicia Owens  2
Affiliations

Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 35 US States and Their Association with Structural Racism

Michael Siegel et al. J Racial Ethn Health Disparities. 2022 Jun.

Abstract

Introduction: While the increased burden of COVID-19 among the Black population has been recognized, most attempts to quantify the extent of this racial disparity have not taken the age distribution of the population into account. In this paper, we determine the Black-White disparity in COVID-19 mortality rates across 35 states using direct age standardization. We then explore the relationship between structural racism and differences in the magnitude of this disparity across states.

Methods: Using data from the Centers for Disease Control and Prevention, we calculated both crude and age-adjusted COVID-19 mortality rates for the non-Hispanic White and non-Hispanic Black populations in each state. We explored the relationship between a state-level structural racism index and the observed differences in the racial disparities in COVID-19 mortality across states. We explored the potential mediating effects of disparities in exposure based on occupation, underlying medical conditions, and health care access.

Results: Relying upon crude death rate ratios resulted in a substantial underestimation of the true magnitude of the Black-White disparity in COVID-19 mortality rates. The structural racism index was a robust predictor of the observed racial disparities. Each standard deviation increase in the racism index was associated with an increase of 0.26 in the ratio of COVID-19 mortality rates among the Black compared to the White population.

Conclusions: Structural racism should be considered a root cause of the Black-White disparity in COVID-19 mortality. Dismantling the long-standing systems of racial oppression is critical to adequately address both the downstream and upstream causes of racial inequities in the disease burden of COVID-19.

Keywords: African Americans; Age-adjusted mortality rates; COVID-19 (coronavirus disease 2019); Health disparities; Structural racism.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Ratio of Black age-adjusted COVID-19 death rate to White age-adjusted COVID-19 death rate as a function of the state racism index. The racism index is on a scale of 0 to 100 with higher numbers indicating a greater level of structural racism. Mortality rates are per 100,000 population
Fig. 2
Fig. 2
Heat map showing the state structural racism index in gradations of color with the ratio of the age-adjusted Black COVID-19 mortality rate to the age-adjusted White COVID-19 mortality rate shown in text in the middle of each state
See this image and copyright information in PMC

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