Socio-economic status and COVID-19-related cases and fatalities

Public Health. 2020 Dec:189:129-134. doi: 10.1016/j.puhe.2020.09.016. Epub 2020 Oct 17.


Objectives: The United States has the highest number of coronavirus disease 2019 (COVID-19) in the world, with high variability in cases and mortality between communities. We aimed to quantify the associations between socio-economic status and COVID-19-related cases and mortality in the U.S.

Study design: The study design includes nationwide COVID-19 data at the county level that were paired with the Distressed Communities Index (DCI) and its component metrics of socio-economic status.

Methods: Severely distressed communities were classified by DCI>75 for univariate analyses. Adjusted rate ratios were calculated for cases and fatalities per 100,000 persons using hierarchical linear mixed models.

Results: This cohort included 1,089,999 cases and 62,298 deaths in 3127 counties for a case fatality rate of 5.7%. Severely distressed counties had significantly fewer deaths from COVID-19 but higher number of deaths per 100,000 persons. In risk-adjusted analysis, the two socio-economic determinants of health with the strongest association with both higher cases per 100,000 persons and higher fatalities per 100,000 persons were the percentage of adults without a high school degree (cases: RR 1.10; fatalities: RR 1.08) and proportion of black residents (cases and fatalities: Relative risk(RR) 1.03). The percentage of the population aged older than 65 years was also highly predictive for fatalities per 100,000 persons (RR 1.07).

Conclusion: Lower education levels and greater percentages of black residents are strongly associated with higher rates of both COVID-19 cases and fatalities. Socio-economic factors should be considered when implementing public health interventions to ameliorate the disparities in the impact of COVID-19 on distressed communities.

Keywords: COVID-19; Coronavirus; Race; SARS-CoV-2; Socio-economic status.

MeSH terms

  • Adult
  • Aged
  • Black or African American / statistics & numerical data
  • COVID-19 / epidemiology*
  • COVID-19 / mortality*
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mortality / trends
  • Prevalence
  • Risk
  • SARS-CoV-2*
  • Social Class*
  • United States / epidemiology