A Geography of Risk: Structural Racism and Coronavirus Disease 2019 Mortality in the United States

Abstract

Coronavirus disease 2019 (COVID-19) is disproportionately burdening racial and ethnic minority groups in the US. Higher risks of infection and mortality among racialized minorities are a consequence of structural racism, reflected in specific policies that date back centuries and persist today. Yet, our surveillance activities do not reflect what we know about how racism structures risk. When measuring racial and ethnic disparities in deaths due to COVID-19, the CDC statistically accounts for the geographic distribution of deaths throughout the US to reflect the fact that deaths are concentrated in areas with different racial and ethnic distributions than that of the larger US. In this commentary, we argue that such an approach misses an important driver of disparities in COVID-19 mortality, namely the historical forces that determine where individuals live, work, and play, and consequently determine their risk of dying from COVID-19. We explain why controlling for geography downplays the disproportionate burden of COVID-19 on racialized minority groups in the US. Finally, we offer recommendations for the analysis of surveillance data to estimate racial disparities, including shifting from distribution-based to risk-based measures, to help inform a more effective and equitable public health response to the pandemic.

Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection

“…Racial and ethnic minorities are disproportionately affected by COVID-19 and thus are at highest risk for PASC-related morbidity, disability, and mortality ( 149 ). Communities of color are more likely to be exposed to COVID-19, more likely to be not receive COVID-19 diagnoses, more likely to experience severe illness, and more likely to ultimately die from COVID-19 ( 150 , 151 , 152 , 153 , 154 , 155 ). This heightened risk stems from multiple structural, socioeconomic, and individual-level factors ( 156 ).…”

Spatiotemporal Associations Between Social Vulnerability, Environmental Measurements, and COVID‐19 in the Conterminous United States

“…While Persad et al. ( 2020 ) have noted that “racial identity is not an inherent risk factor,” “COVID‐19 disparities reflect the health, environmental, and occupational effects of structural racism.” Numerous researchers have highlighted the underfunding of preventative public health infrastructure, an inefficient healthcare system, inadequate governmental response, and systemically racist policies that have exacerbated the pandemic's effects (Egede & Walker, 2020 ; Hanage et al., 2020 ; Hathaway, 2020 ; Yearby & Mohapatra, 2020 ; Zalla et al., 2021 ). However, one highly probable contributor is the number and extent of socially vulnerable communities within the United States that demonstrate reduced resiliency in the face of a hazard (Karaye & Horney, 2020 ; Khazanchi et al., 2020 ; Shi & Stevens, 2021 ).…”

COVID-19 Medical Vulnerability Indicators: A Predictive, Local Data Model for Equity in Public Health Decision Making

“…These indicators illustrated how multiple factors associated with an increased risk of COVID-19 infections and mortality—pre-existing health conditions, barriers to accessing health care, built environment risk, and social vulnerability—can identify people and areas of potential infections [ 49 , 50 ]. These indicators were able to illustrate the different levels of vulnerability across Los Angeles County geographic areas and which racial/ethnic minorities are most vulnerable to exposure to infection in those areas [ 51 , 52 ].…”