Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 23;16(7):e0255063.
doi: 10.1371/journal.pone.0255063. eCollection 2021.

The synchronicity of COVID-19 disparities: Statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America

Brian E Dixon  1   2 , Shaun J Grannis  2   3 , Lauren R Lembcke  4 , Nimish Valvi  2 , Anna R Roberts  4 , Peter J Embi  2   5
Affiliations

The synchronicity of COVID-19 disparities: Statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America

Brian E Dixon et al. PLoS One. .

Abstract

Background: Early studies on COVID-19 identified unequal patterns in hospitalization and mortality in urban environments for racial and ethnic minorities. These studies were primarily single center observational studies conducted within the first few weeks or months of the pandemic. We sought to examine trends in COVID-19 morbidity, hospitalization, and mortality over time for minority and rural populations, especially during the U.S. fall surge.

Methods: Data were extracted from a statewide cohort of all adult residents in Indiana tested for SARS-CoV-2 infection between March 1 and December 31, 2020, linked to electronic health records. Primary measures were per capita rates of infection, hospitalization, and death. Age adjusted rates were calculated for multiple time periods corresponding to public health mitigation efforts. Comparisons across time within groups were compared using ANOVA.

Results: Morbidity and mortality increased over time with notable differences among sub-populations. Initially, hospitalization rates among racial minorities were 3-4 times higher than whites, and mortality rates among urban residents were twice those of rural residents. By fall 2020, hospitalization and mortality rates in rural areas surpassed those of urban areas, and gaps between black/brown and white populations narrowed. Changes across time among demographic groups was significant for morbidity and hospitalization. Cumulative morbidity and mortality were highest among minority groups and in rural communities.

Conclusions: The synchronicity of disparities in COVID-19 by race and geography suggests that health officials should explicitly measure disparities and adjust mitigation as well as vaccination strategies to protect those sub-populations with greater disease burden.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Per capita rates for hospitalizations and deaths due to COVID-19 among adults in Indiana, stratified by race, during three distinct time periods between March 1 and December 31, 2020.
State of Indiana.
Fig 2
Fig 2. Weekly COVID-19 incidence, defined as cases per 100,000 population, among adults in Indiana, stratified by urban versus rural county of residence between March 1 and December 31, 2020.
State of Indiana.
Fig 3
Fig 3. Weekly rates per capita for hospitalizations and deaths due to COVID-19 among adults in Indiana, stratified by urban versus rural county of residence between March 1 and December 31, 2020.
See this image and copyright information in PMC

References

    1. Center for Systems Science and Engineering. COVID-19 Dashboard Baltimore: Johns Hopkins University; 2020 [cited 2020 Jul 19]. Available from: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594....
    1. Centers for Disease Control and Prevention US. COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity—Report for Week 52 Atlanta, GA: Department of Health and Human Services, U.S.; 2020. [updated Dec 26; cited 2021 Jan 5]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/pdf/covidview-01-04....
    1. Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical Features of 69 Cases With Coronavirus Disease 2019 in Wuhan, China. Clinical Infectious Diseases. 2020. doi: 10.1093/cid/ciaa272 - DOI - PMC - PubMed
    1. Buckner FS, McCulloch DJ, Atluri V, Blain M, McGuffin SA, Nalla AK, et al.. Clinical Features and Outcomes of 105 Hospitalized patients with COVID-19 in Seattle, Washington. Clin Infect Dis. 2020. Epub 2020/05/24. doi: 10.1093/cid/ciaa632 ; PubMed Central PMCID: PMC7314181. - DOI - PMC - PubMed
    1. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al.. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. Jama. 2020;323(16):1574–81. Epub 2020/04/07. doi: 10.1001/jama.2020.5394 ; PubMed Central PMCID: PMC7136855. - DOI - PMC - PubMed

Publication types