County-level socio-economic disparities in COVID-19 mortality in the USA

Int J Epidemiol. 2022 May 9;51(2):418-428. doi: 10.1093/ije/dyab267.


Background: Preliminary studies have suggested a link between socio-economic characteristics and COVID-19 mortality. Such studies have been carried out on particular geographies within the USA or selective data that do not represent the complete experience for 2020.

Methods: We estimated COVID-19 mortality rates, number of years of life lost to SARS-CoV-2 and reduction in life expectancy during each of the three pandemic waves in 2020 for 3144 US counties grouped into five socio-economic status categories, using daily death data from the Johns Hopkins University of Medicine and weekly mortality age structure from the Centers for Disease Control.

Results: During March-May 2020, COVID-19 mortality was highest in the most socio-economically advantaged quintile of counties and lowest in the two most-disadvantaged quintiles. The pattern reversed during June-August and widened by September-December, such that COVID-19 mortality rates were 2.58 times higher in the bottom than in the top quintile of counties. Differences in the number of years of life lost followed a similar pattern, ultimately resulting in 1.002 (1.000, 1.004) million years in the middle quintile to 1.381 (1.378, 1.384) million years of life lost in the first (most-disadvantaged) quintile during the whole year.

Conclusions: Diverging trajectories of COVID-19 mortality among the poor and affluent counties indicated a progressively higher rate of loss of life among socio-economically disadvantaged communities. Accounting for socio-economic disparities when allocating resources to control the spread of the infection and to reinforce local public health infrastructure would reduce inequities in the mortality burden of the disease.

Keywords: COVID-19; Mortality; age-standardized death rates; the USA; years of life lost.

Publication types

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

MeSH terms

  • COVID-19*
  • Health Status Disparities
  • Humans
  • Mortality
  • Pandemics
  • SARS-CoV-2
  • Social Class
  • United States / epidemiology