Population-Level Disparities in Exposure to COVID-19 Mitigation Policies, April 2020-April 2021

J Public Health Manag Pract. 2023 Nov-Dec;29(6):874-881. doi: 10.1097/PHH.0000000000001777. Epub 2023 Jul 26.

Abstract

Context: Studies have found that COVID-19 stay-at-home orders (SHOs) and face mask policies (FMPs) were associated with reduced COVID-19 transmission and deaths. But it is unknown whether exposure to these policies varied by sociodemographic characteristics across the US population.

Objective: The goal of this study was to quantify and characterize the sociodemographic characteristics and geographic distribution of populations exposed to evidence-based COVID-19 mitigation policies.

Design: We obtained statewide SHOs and FMPs for all US counties from April 10, 2020, to April 10, 2021, calculated median policy lengths, and categorized counties into 4 groups based on length of policy exposure: low SHO-low FMP, high SHO-low FMP, low SHO-high FMP, and high SHO-high FMP. We described exposure groups by COVID-19 cumulative case/death and vaccination rates and county sociodemographic characteristics.

Setting: In total, 3142 counties from all 50 states and Washington, District of Columbia, were included in the analysis.

Main outcome measures: County-level sociodemographic factors and county cumulative rates for COVID-19 cases, deaths, and vaccinations.

Results: The largest percentage of the US population lived in counties with high exposure to SHOs and FMPs. However, populations living in high SHO-high FMP counties had the lowest percent non-Hispanic Black (NHB) and highest percent non-Hispanic White (NHW) populations. Populations living in high SHO-low FMP counties had the highest percent NHB and Hispanic populations and the lowest percent NHW population.

Conclusion: This study identified county-level racial, ethnic, and sociodemographic disparities in exposure to evidence-based statewide COVID-19 mitigation policies.

Policy implications: Exposure to evidence-based policies is an important consideration for studies evaluating the root causes of health inequities.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • Ethnicity
  • Health Status Disparities
  • Humans
  • Policy
  • Racial Groups
  • United States / epidemiology

Substances

  • 2-(4-fluorophenyl)-N-methylsuccinimide