Association Between State-Level Income Inequality and COVID-19 Cases and Mortality in the USA

Oronce, Carlos Irwin A.; Scannell, Christopher A.; Kawachi, Ichiro; Tsugawa, Yusuke

doi:10.1007/s11606-020-05971-3

Cited by 139 publications

(124 citation statements)

References 2 publications

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“…To our knowledge, this is the first study to show that cross-national differences in COVID-19 mortality relate to income inequality. This finding aligns with studies that found associations between inequality and various measures of population health ( Pickett and Wilkinson, 2015 ; Ram, 2006 ) and recent evidence from the United States ( Mollalo et al, 2020 ; Oronce et al, 2020 ). The association held up to multiple controls, including country wealth and social capital, and therefore is not well explained by differences in trust, as suggested elsewhere ( Pickett and Wilkinson, 2015 ).…”

Section: Discussionsupporting

confidence: 91%

“…New research (e.g., Ahmed et al, 2020 ; Takian et al, 2020 ) has observed a similar pattern in COVID-19, with more transmission and worse health outcomes in poorer populations due to overcrowded housing and work conditions. Some research in the US recently found moderate correlations between state-level income inequality and COVID-19 cases and deaths ( Mollalo et al, 2020 ; Oronce et al, 2020 ) and other communicable disease (e.g., sexually transmitted disease, tuberculosis; Holtgrave and Crosby, 2003 , 2004 ), however cross-national evidence of a contextual association with COVID-19 is scarce.…”

Section: Introductionmentioning

confidence: 99%

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The trouble with trust: Time-series analysis of social capital, income inequality, and COVID-19 deaths in 84 countries

Elgar

Stefaniak

Wohl

2020

Social Science & Medicine

240

210

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Can social contextual factors explain international differences in the spread of COVID-19? It is widely assumed that social cohesion, public confidence in government sources of health information and general concern for the welfare of others support health advisories during a pandemic and save lives. We tested this assumption through a time-series analysis of cross-national differences in COVID-19 mortality during an early phase of the pandemic. Country data on income inequality and four dimensions of social capital (trust, group affiliations, civic responsibility and confidence in public institutions) were linked to data on COVID-19 deaths in 84 countries. Associations with deaths were examined using Poisson regression with population-averaged estimators. During a 30-day period after recording their tenth death, mortality was positively related to income inequality, trust and group affiliations and negatively related to social capital from civic engagement and confidence in state institutions. These associations held in bivariate and mutually controlled regression models with controls for population size, age and wealth. The results indicate that societies that are more economically unequal and lack capacity in some dimensions of social capital experienced more COVID-19 deaths. Social trust and belonging to groups were associated with more deaths, possibly due to behavioural contagion and incongruence with physical distancing policy. Some countries require a more robust public health response to contain the spread and impact of COVID-19 due to economic and social divisions within them.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The trouble with trust: Time-series analysis of social capital, income inequality, and COVID-19 deaths in 84 countries

Elgar

Stefaniak

Wohl

2020

Social Science & Medicine

240

210

View full text Add to dashboard Cite

show abstract

“…As the pandemic has progressed in the US, it has become clear that, the impact of COVID-19 has been felt more acutely in some communities,[ 8 , 9 ] most clearly among Black Americans, who acquire the disease and die at disproportionate rates. [ [10] , [11] , [12] ] Social determinants of health may drive some of this disparity, and neighborhood traits may be particularly relevant, given that infectious disease spread is often influenced by the built environment.…”

Section: Introductionmentioning

confidence: 99%

Coronavirus disease 2019 (COVID-19) mortality and neighborhood characteristics in Chicago

Bryan

Sun

Jagai

et al. 2021

Annals of Epidemiology

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“…For example, age structure explained part of the between-country differences in COVID-19 mortality and case-fatality rates [4,20]; median prevalence of the five conditions most frequently associated with severe COVID-19 in USA allowed to identify the areas at highest risk for COVID-19 death [21]; age-specific prevalence of comorbidities explained the differences in mortality between Nigeria, Brazil and Italy [22]. Economic and healthcare associated variables are other aggregated data potentially useful to predict COVID-19 severity and spread [68][69][70], as well as inequalities within the general population [71]. Unlike these studies, however, the present analysis considered the mortality rate from an infectious disease that was not somewhat causally associated with COVID-19 mortality and death and was based on a different assumption, namely, that the two diseases shared a set of determinants, ranging from the characteristics of the population at highest risk, to transmission routes, from case and death misclassifications, to the efficiency of the healthcare systems.…”

Section: Determinantmentioning

confidence: 99%

Ecologic association between influenza and COVID-19 mortality rates in European countries

Petti¹,

Cowling

2020

Epidemiol. Infect.

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Ecologic studies investigating COVID-19 mortality determinants, used to make predictions and design public health control measures, generally focused on population-based variable counterparts of individual-based risk factors. Influenza is not causally associated with COVID-19, but shares population-based determinants, such as similar incidence/mortality trends, transmission patterns, efficacy of non-pharmaceutical interventions, comorbidities and underdiagnosis. We investigated the ecologic association between influenza mortality rates and COVID-19 mortality rates in the European context. We considered the 3-year average influenza (2014–2016) and COVID-19 (31 May 2020) crude mortality rates in 34 countries using EUROSTAT and ECDC databases and performed correlation and regression analyses. The two variables – log transformed, showed significant Spearman's correlation ρ = 0.439 (P = 0.01), and regression coefficients, b = 0.743 (95% confidence interval, 0.272–1.214; R2 = 0.244; P = 0.003), b = 0.472 (95% confidence interval, 0.067–0.878; R2 = 0.549; P = 0.02), unadjusted and adjusted for confounders (population size and cardiovascular disease mortality), respectively. Common significant determinants of both COVID-19 and influenza mortality rates were life expectancy, influenza vaccination in the elderly (direct associations), number of hospital beds per population unit and crude cardiovascular disease mortality rate (inverse associations). This analysis suggests that influenza mortality rates were independently associated with COVID-19 mortality rates in Europe, with implications for public health preparedness, and implies preliminary undetected SARS-CoV-2 spread in Europe.

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Association Between State-Level Income Inequality and COVID-19 Cases and Mortality in the USA

Abstract: Figure 1 The unadjusted correlation between the state-level Gini index and the number of COVID-19 cases (a) and deaths (b).

Cited by 139 publications

References 2 publications

The trouble with trust: Time-series analysis of social capital, income inequality, and COVID-19 deaths in 84 countries

The trouble with trust: Time-series analysis of social capital, income inequality, and COVID-19 deaths in 84 countries

Coronavirus disease 2019 (COVID-19) mortality and neighborhood characteristics in Chicago

Ecologic association between influenza and COVID-19 mortality rates in European countries

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