Community-Level Factors Associated With Racial And Ethnic Disparities In COVID-19 Rates In Massachusetts

Health Aff (Millwood). 2020 Nov;39(11):1984-1992. doi: 10.1377/hlthaff.2020.01040. Epub 2020 Aug 27.


Massachusetts has one of the highest cumulative incidence rates of coronavirus disease 2019 (COVID-19) cases in the US. Understanding which specific demographic, economic, and occupational factors have contributed to disparities in COVID-19 incidence rates across the state is critical to informing public health strategies. We performed a cross-sectional study of 351 Massachusetts cities and towns from January 1 to May 6, 2020, and found that a 10-percentage-point increase in the Black non-Latino population was associated with an increase of 312.3 COVID-19 cases per 100,000 population, whereas a 10-percentage-point increase in the Latino population was associated with an increase of 258.2 cases per 100,000. Independent predictors of higher COVID-19 rates included the proportion of foreign-born noncitizens living in a community, mean household size, and share of food service workers. After adjustment for these variables, the association between the Latino population and COVID-19 rates was attenuated. In contrast, the association between the Black population and COVID-19 rates persisted but may be explained by other systemic inequities. Public health and policy efforts that improve care for foreign-born noncitizens, address crowded housing, and protect food service workers may help mitigate the spread of COVID-19 among minority communities.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Betacoronavirus / isolation & purification
  • COVID-19
  • Coronavirus Infections / epidemiology*
  • Ethnicity / statistics & numerical data*
  • Female
  • Health Status Disparities*
  • Humans
  • Incidence
  • Male
  • Massachusetts / epidemiology
  • Middle Aged
  • Minority Groups / statistics & numerical data
  • Morbidity
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • Racial Groups*
  • SARS-CoV-2