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. 2022 Feb;9(1):236-246.
doi: 10.1007/s40615-020-00948-8. Epub 2021 Jan 19.

Structural Racism and COVID-19 in the USA: a County-Level Empirical Analysis

Shin Bin Tan  1   2 , Priyanka deSouza  3 , Matthew Raifman  4
Affiliations

Structural Racism and COVID-19 in the USA: a County-Level Empirical Analysis

Shin Bin Tan et al. J Racial Ethn Health Disparities. 2022 Feb.

Abstract

Substantial health disparities exist across race/ethnicity in the USA, with Black Americans often most affected. The current COVID-19 pandemic is no different. While there have been ample studies describing racial disparities in COVID-19 outcomes, relatively few have established an empirical link between these disparities and structural racism. Such empirical analyses are critically important to help defuse "victim-blaming" narratives about why minority communities have been badly hit by COVID-19. In this paper, we explore the empirical link between structural racism and disparities in county-level COVID-19 outcomes by county racial composition. Using negative binomial regression models, we examine how five measures of county-level residential segregation and racial disparities in socioeconomic outcomes as well as incarceration rates are associated with county-level COVID-19 outcomes. We find significant associations between higher levels of measured structural racism and higher rates of COVID-19 cases and deaths, even after adjusting for county-level population sociodemographic characteristics, measures of population health, access to healthcare, population density, and duration of the COVID-19 outbreak. One percentage point more Black residents predicted a 1.1% increase in county case rate. This association decreased to 0.4% when structural racism indicators were included in our model. Similarly, one percentage point more Black residents predicted a 1.8% increase in county death rates, which became non-significant after adjustment for structural racism. Our findings lend empirical support to the hypothesis that structural racism is an important driver of racial disparities in COVID-19 outcomes, and reinforce existing calls for action to address structural racism as a fundamental cause of health disparities.

Keywords: COVID-19; Race; Residential segregation, disparities; Structural racism.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Geographical distribution of structural racism measures
Fig. 2
Fig. 2
Correlation between model variables
Fig. 3
Fig. 3
Number of cases and number of deaths per thousand population, as of September 25, 2020. Counties outlined in gray were left out of the analysis, because of missing information. Note: Only continental states included in the maps
See this image and copyright information in PMC

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