County-Level Segregation and Racial Disparities in COVID-19 Outcomes

Abstract

Context: Segregation has been linked to unequal life chances. Individuals from marginalized communities experience more crime, higher levels of poverty, poor health, and less civic engagement; and segregated metropolitan regions witness inequality in access to basic services. This paper builds on this previous work by linking segregation to infection and deaths from COVID-19. Methods: Using Census data matched to COVID infection and death statistics at the county level, we offer a theoretical basis for our choice of segregation measures and predictions for different racial groups. We analyze the relationship between two dimensions of segregation, racial isolation and racial unevenness, and COVID outcomes for different racial and ethnic groups. Findings: We find that in counties where Black and Latino residents live in more isolated neighborhoods, they were much more likely to contract COVID-19. This pattern was exacerbated in counties with a high proportion of front-line workers. We also find that racial segregation increased COVID-19 death rates for Black, Latino, and white residents. Conclusions: Our findings suggest that devastating outcomes of the coronavirus pandemic were linked to a long history of racial marginalization and entrenched discrimination produced by structural inequalities embedded in our geographies and should inform public health planning going forward.

Pandemic distress associated with segregation and social stressors

“…Racial segregation reinforces health disparities by limiting access to resources that impact health-such as education, income, and occupation (32)(33)(34)(35)(36)(37)(38). These limitations were exacerbated during Covid-19 where individuals of color who have experienced a lifetime of exposure to racial segregation also experienced worse quality of and access to health care and social support (32,36).…”

“…Minority communities, particularly Black communities, are disproportionately marginalized through both historical and current segregation (29)(30)(31)(32). Segregation is associated with substantially more vulnerability to Covid-19 through several mechanisms, including increased household density, reliance on crowded transportation services, and lower access to healthcare services (34)(35)(36)(37)(38). Additionally, segregation exacerbates socioeconomic difficulties through limited access to employment and educational opportunities (34)(35)(36).…”

“…Segregation is associated with substantially more vulnerability to Covid-19 through several mechanisms, including increased household density, reliance on crowded transportation services, and lower access to healthcare services (34)(35)(36)(37)(38). Additionally, segregation exacerbates socioeconomic difficulties through limited access to employment and educational opportunities (34)(35)(36). For households in segregated neighborhoods, it is often much more difficult to recover from sudden socioeconomic challenges related to the pandemic, such as healthcare costs or the loss of employment.…”

Homelessness, Politics, and Policy: Predicting Spatial Variation in COVID-19 Cases and Deaths

“…In counties where Black and Latino residents lived in more isolated neighborhoods, especially if the county had a high proportion of front-line workers, these individuals were much more likely to contract COVID-19. Likewise, racial segregation increased COVID-19 death rates for Black, Latino, and white residents [ 14 ]. However, as white rates increased over time, racial disparities in infections and death declined [ 15 ].…”