COVID‐19 Death Rates Are Higher in Rural Counties With Larger Shares of Blacks and Hispanics

Abstract

This study compared the average daily increase in COVID-19 mortality rates by county racial/ethnic composition (percent non-Hispanic Black and percent Hispanic) among US rural counties. Methods: COVID-19 daily death counts for 1,976 US nonmetropolitan counties for the period March 2-July 26, 2020, were extracted from USAFacts and merged with county-level American Community Survey and Area Health Resource File data. Covariates included county percent poverty, age composition, adjacency to a metropolitan county, health care supply, and state fixed effects. Mixed-effects negative binomial regression with random intercepts to account for repeated observations within counties were used to predict differences in the average daily increase in the COVID-19 mortality rate across quartiles of percent Black and percent Hispanic. Findings: Since early March, the average daily increase in the COVID-19 mortality rate has been significantly higher in rural counties with the highest percent Black and percent Hispanic populations. Compared to counties in the bottom quartile, counties in the top quartile of percent Black have an average daily increase that is 70% higher (IRR = 1.70, CI: 1.48-1.95, P < .001), and counties in the top quartile of percent Hispanic have an average daily increase that is 50% higher (IRR = 1.50, CI: 1.33-1.69, P < .001), net of covariates. Conclusion: COVID-19 mortality risk is not distributed equally across the rural United States, and the COVID-19 race penalty is not restricted to cities. Among rural counties, the average daily increase in COVID-19 mortality rates has been significantly higher in counties with the largest shares of Black and Hispanic residents.

Racial/Ethnic Heterogeneity and Rural-Urban Disparity of COVID-19 Case Fatality Ratio in the USA: a Negative Binomial and GIS-Based Analysis

“…Figure 3 elucidates that rural counties in the panhandle and southern part of Texas, the western part of New Mexico, Louisiana, Mississippi, Alabama, and Georgia, South Carolina, South of Illinois, and North of South Virginia have significant hotspots of COVID-19 CFR compared to some rural counties in Colorado and California. Most of these counties also have a significant proportion of BIPOC, which aligns with another study that indicates that COVID-19 deaths are higher in rural counties with a higher share of Black and Hispanic populations [ 11 ]. The significant hotspot could be attributed to some of the determinants of health, such as poor access to medical and socioeconomic resources.…”

“…Since the disease outbreak, several attempts have been made to investigate factors driving the variability of COVID-19 infection, mortality rate, and CFR at different geographic scales using different approaches [ 11 , 21 – 25 ]. A multicountry study shows that the political regime, economic parameters, chronic health conditions, behavioral factors (e.g., smoking), and demography are associated with CFR variation among countries [ 22 ].…”

“…Previous COVID-19 studies have shown that COVID-19 disproportionately affects rural communities with a high percentage of minority racial/ethnic groups [ 11 – 14 ]. Following recent studies that focus on the disparity in COVID-19 burden by race and ethnicity in rural areas, this paper examined racial heterogeneity in COVID-19 CFR in the USA.…”

The Risk of Clinical Complications and Death among Pregnant Women with COVID-19&nbsp;

“…For example, an investigation of racial disparity in pregnancy outcomes at a tertiary care medical center found that while black women were more likely, compared to whites, to remain in the hospital for > 4 days, have higher rates of preterm birth, small-for-gestationalage infants, preeclampsia, and stillbirths, hispanic women were found to have lower odds for preterm birth and when compared to black women, hispanic women were less likely to experience any adverse pregnancy events, with the exception of gestational diabetes mellitus. 46 Here, we refer to the Hispanic paradox; the positive health outcomes observed among Hispanic populations despite risks associated with lower SES 47 as a likely explanation while acknowledging that other COVID-19 studies have reported adverse effects in Hispanic populations 48 in general but not among pregnant women in particular. 25 Given that advanced maternal age has been associated with a host of adverse pregnancy outcomes our ndings highlight the need for providers to pay close attention to pregnant women of advanced ages who contract COVID-19.…”

Understanding Convergence Between Non-Hispanic Black and White COVID-19 Mortality: A County-Level Approach

“…Black Americans often live in dense urban environments that can increase exposure to COVID-19 (Adhikari et al, 2020; Kirby, 2020; Stokes et al, 2021). Other studies have tied COVID-19 racial disparities to differences in access to care, economic status, chronic comorbidities, and “essential worker” categorization (Cheng et al, 2020; Paul et al, 2020; Wright et al, 2020). These studies primarily correlate the racial make-up of the population to total COVID-19 mortality, rather than disaggregated mortality data by race.…”