Racial, ethnic, and socioeconomic disparities in confirmed COVID-19 cases and deaths in the United States: a county-level analysis as of November 2020

Ethn Health. 2021 Jan;26(1):22-35. doi: 10.1080/13557858.2020.1853067. Epub 2020 Dec 17.


Objectives: The objective of this study was to investigate potential county-level disparities among racial/ethnic and socioeconomic groups in confirmed COVID-19 cases and deaths in the United States in 100,000 population.

Design: Secondary data analysis using county-level data for 3,142 US counties was conducted in 2020. Hierarchical linear regression and concentration curve analyses were performed. The combined association of COVID-19 cases and deaths was examined separately by the county population's socioeconomic characteristics. Data from the American Community Survey (ACS) 5-year estimates (2014-2018), Area Health Resources File (AHRF) 2018-2019, Kaiser Health News 2020, and 2020 COVID-19 data from Johns Hopkins University were used in this study.

Results: After adjusting for covariates, U.S. counties with a higher proportion of the Black population and a higher proportion of adults with less than a high school diploma had disproportionately higher COVID-19 cases and deaths (β > 0, p<0.05 for all relations). A higher proportion of the Hispanic population was associated with higher confirmed cases (β = 0.68, 95% CI = 0.48-0.87). The majority observed disparities in COVID-19 deaths persisted even after controlling for all-cause deaths in 2019 and COVID-19 cases per 100,000 county population. This can potentially aggravate the existing health disparities among these population groups.

Conclusions: Identification of disproportionately impacted population groups can pave the way towards narrowing the disparity gaps and guide policymakers and stakeholders in designing and implementing population group-specific interventions to mitigate the negative consequences of the COVID-19 pandemic.

Keywords: COVID-19; health disparities; minority health; pandemics; socioeconomic factors.

MeSH terms

  • Adult
  • COVID-19* / epidemiology
  • COVID-19* / ethnology
  • Ethnicity / statistics & numerical data*
  • Female
  • Health Status Disparities*
  • Humans
  • Male
  • Mortality* / ethnology
  • Mortality* / trends
  • Racial Groups*
  • Socioeconomic Factors*
  • United States / epidemiology