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
. 2022 Oct;9(5):1697-1725.
doi: 10.1007/s40615-021-01109-1. Epub 2021 Aug 30.

Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 353 US Counties and Their Association with Structural Racism

Michael Siegel  1 , Isabella Critchfield-Jain  2 , Matthew Boykin  2 , Alicia Owens  2 , Taiylor Nunn  2 , Rebeckah Muratore  2
Affiliations

Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 353 US Counties and Their Association with Structural Racism

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

Abstract

Introduction: Although disparities in COVID-19 mortality have been documented at the national and state levels, no previous study has quantified such disparities at the county level by explicitly measuring race-specific COVID-19 death rates. In this paper, we quantify the racial/ethnic disparities in COVID-19 mortality between the non-Hispanic Black and non-Hispanic White populations at the county level by estimating age-adjusted, race-specific death rates.

Methods: Using COVID-19 case data from the Centers for Disease Control and Prevention, we calculated crude and indirect age-adjusted COVID-19 mortality rates for the non-Hispanic White and non-Hispanic Black populations in each of 353 counties for the period February 2, 2020, through January 30, 2021. Using linear regression analysis, we examined the relationship between several county-level measures of structural racism and the observed differences in racial disparities in COVID-19 mortality across counties.

Results: Ninety-three percent of the counties in our study experienced higher death rates among the Black compared to the White population, with an average ratio of Black to White death rates of 1.9 and a 17.5-fold difference between the disparity in the lowest and highest counties. Three traditional measures of structural racism were significantly related to the magnitude of the Black-White racial disparity in COVID-19 mortality rates across counties.

Conclusions: There are large disparities in COVID-19 mortality rates between the Black and White populations at the county level, there are profound differences in the level of these disparities, and those differences are directly related to the level of structural racism in a given county.

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

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Location of 353 counties in sample. The size of the circle indicates the magnitude of the Black-White racial disparity in age-adjusted COVID-19 mortality rates
See this image and copyright information in PMC

References

    1. Lee FC, Adams L, Graves SJ, Massetti GM, Calanan RM, Penman-Aguilar A, Jenley SJ, et al. Counties with high COVID-19 incidence and relatively large racial and ethnic minority populations—United States, April 1-December 22, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(13):483–489. doi: 10.15585/mmwr.mm7013e1. - DOI - PMC - PubMed
    1. Bassett MT, Chen JT, Krieger N. Variation in racial/ethnic disparities in COVID-19 mortality by age in the United States: a cross-sectional study. PLoS Med. 2020;17(10):e1003402. doi: 10.1371/journal.pmed.1003402. - DOI - PMC - PubMed
    1. Gross CP, Essien UR, Pasha S, Gross JR, Wang S, Nunez-Smith M. Racial and ethnic disparities in population-level Covid-19 mortality. J Gen Intern Med. 2020;35(10):3097–3099. doi: 10.1007/s11606-020-06081-w. - DOI - PMC - PubMed
    1. Gaglioti AH, Li C, Douglas MD, Baltrus PT, Blount MA, Zahidi R, Caplan LS, Willock RJ, Fasuyi OB, Mack DH. Population-level disparities in COVID-19: measuring the independent association of the proportion of Black population on COVID-19 cases and deaths in US counties. J Public Health Manag Pract. 2021;27(3):268–277. doi: 10.1097/PHH.0000000000001354. - DOI - PubMed
    1. Figueroa JF, Wadhera RK, Mehtsun WT, Riley K, Phelan J, Jha AK. Association of race, ethnicity, and community-level factors with COVID-19 cases and deaths across U.S. counties. Healthcare. 2021;(9):100495. 10.1016/j.hjdsi.2020.100495. Accessed 26 Jan 2021. - PMC - PubMed

LinkOut - more resources