An Ecologic Study of Disparities in COVID-19 Incidence and Case Fatality in Oakland County, MI, USA, During a State-Mandated Shutdown

Abstract

Introduction Data from the USA reveal disparities in hospitalization and mortality from coronavirus disease 2019 (COVID-19). Social determinants of health (SDoH) could account for disparities in disease incidence and outcomes. We investigated the association between zip code racial composition and COVID-19 incidence and case fatality in Oakland County, MI. Methods We conducted an ecological study using publicly available data on COVID-19 in 70 zip codes in Oakland County, MI. We obtained demographic surrogate markers of SDoH by zip code from the US Census Bureau website. Using negative binomial regression models, we investigated the association between the percentage of Blacks in each zip code and COVID-19 incidence and case fatality, including markers of SDoH as potential confounders. Results Reported COVID-19 cases ranged from 13.2 to 255.2 per 10,000 population. Each percentage increase in Blacks within a zip code was associated with a 3% increase in COVID-19 cases (95% CI: 1.02 to 1.04, p ≤ 0.0001), and this remained significant after adjusting for income or poverty level, number of persons per household, mode of transportation, age, and level of education (incidence rate ratio: 1.02, 95% CI: 1.01 to 1.03, p ≤ 0.0001). Zip codes with a higher percentage of Blacks also experienced a faster increase in COVID-19 rates from April 3 to May 16. However, the proportion of Blacks in a zip code was not associated with case fatality. Conclusion Zip codes with larger Black populations were disproportionately affected by COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-020-00909-1.

Racial disparities in COVID-19 impacts in Michigan, USA

“…Such pre-existing conditions are often attributed to social determinants of health, which have been shown to have significant deleterious effects on communities of color, and especially Black communities [6,9,13,30,34]. Our results are consistent with emerging trends suggesting that Black American adults are more directly impacted by COVID-19 than their White counterparts [23,4,1,24,19,29,2,28]. Notably, some epidemiological data suggest that almost 90% of primarily Black communities reported COVID-19 related morbidity and almost 50% mortality rates [23].…”

“…Although these differences by race and political ideology were expected based on prior reports [8,11,14,1,24,19,29,2,28], we also observed a race-by-ideology interaction for several COVID-19 impacts. Although a respondent's political ideology is associated with their assessment of COVID-19's threat, their approval of government responses, and their adoption of behavioral changes, these associations are stronger for White respondents than Black respondents.…”

“…Since the first confirmed case of the novel coronavirus (COVID- 19) was reported in the United States on January 22, 2020, there has been an dramatic increase in morbidity and mortality rates due to the virus. Multiple studies of emerging national and local data suggests that communities of color are disparately affected by COVID-19, thus exacerbating existing health disparities [e.g., 1,24,19,29,2,28]. In the state of Michigan, for example, Blacks comprise approximately 14.1% of the population yet make up more than 35% of deaths as of 5 November 2020 [22].…”

“…For instance, hospitalization data from New York City suggest that Blacks are twice as likely to require COVID-related hospitalizations compared to their White peers [29], and Blacks were disproportionately represented in COVIDrelated mortality cases compared to Whites. Other work suggests that communities with greater concentrations of Blacks showed substantially more cases of COVID-19 [1,2,19] These findings may be partially explained by the fact that Blacks are more likely to present with comorbidities such as hypertension and Type 2 diabetes than their White counterparts, and are also disproportionately affected by stress and other social determinants of health such as unemployment and lack of adequate access to healthcare [28].…”

Elevated COVID19 mortality risk in Detroit area hospitals among patients from census tracts with extreme socioeconomic vulnerability

“…Recent geographic-level analyses similarly associated elevated COVID19 mortality risk (or risk of severe infection) with the proportion of residents identified as Black or African American (or other racial/ethnic minorities) [24À27], household overcrowding or population density [28], and socioeconomic vulnerability [3,4,29,30]. Yet, not all findings are consistent; e.g., there was no racial disparity in COVID19 mortality rates among ZIP codes grouped by the proportion of Black residents in a nearby (affluent) county [31]. Clinical studies have also provided evidence that African Americans who seek hospital care are at increased risk of COVID19 mortality; however, the racial disparities appear to be explained by social factors or differences in comorbidities in most [8À11], but not all [7,12], reports.…”