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. 2023 Feb 2;18(2):e0274470.
doi: 10.1371/journal.pone.0274470. eCollection 2023.

Race, employment, and the pandemic: An exploration of covariate explanations of COVID-19 case fatality rate variance

Christopher Griffin  1 , Ray Block Jr  2 , Justin D Silverman  3 , Jason Croad  4 , Robert P Lennon  4
Affiliations

Race, employment, and the pandemic: An exploration of covariate explanations of COVID-19 case fatality rate variance

Christopher Griffin et al. PLoS One. .

Abstract

We derive a simple asymptotic approximation for the long-run case fatality rate of COVID-19 (alpha and delta variants) and show that these estimations are highly correlated to the interaction between US State median age and projected US unemployment rate (Adj. r2 = 60%). We contrast this to the high level of correlation between point (instantaneous) estimates of per state case fatality rates and the interaction of median age, population density and current unemployment rates (Adj. r2 = 50.2%). To determine whether this is caused by a "race effect," we then analyze unemployment, race, median age and population density across US states and show that adding the interaction of African American population and unemployment explains 53.5% of the variance in COVID case fatality rates for the alpha and delta variants when considering instantaneous case fatality rate. Interestingly, when the asymptotic case fatality rate is used, the dependence on the African American population disappears, which is consistent with the fact that in the long-run COVID does not discriminate on race, but may discriminate on access to medical care which is highly correlated to employment in the US. The results provide further evidence of the impact inequality can have on case fatality rates in COVID-19 and the impact complex social, health and economic factors can have on patient survival.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Asymptotic behavior of case fatality rates for various states.
Fig 2
Fig 2. Comparison of the instantaneous case fatality rate and proportion of people tested in each state shows no correlation.
Fig 3
Fig 3. Case fatality rate for the US as a whole through April 2021 with various multiples.
Fig 4
Fig 4. Comparison of the true case fatality rate (ending April 2021) and the projected case fatality rate.
Fig 5
Fig 5. The correction region showing the projection of the case rates forward agrees with the computed correction factor for the four outlier states.
Fig 6
Fig 6. Case fatality rate (April 2021) compared to unemployment rate across states and for various population densities.
The median of the median age is used for all plots.
Fig 7
Fig 7. The relationship between projected unemployment and unemployment in August 2019.
Fig 8
Fig 8. When interacting with median age, asymptotic unemployment explains 60% of the variance in asymptotic case fatality rates.
See this image and copyright information in PMC

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Supplementary concepts