Race, employment, and the pandemic: An exploration of covariate explanations of COVID-19 case fatality rate variance

Abstract

We derive a simple asymptotic approximation for the long-run case fatality rate of COVID-19 (alpha and delta variants) and show that these estimations are highly correlated to the interaction between US State median age and projected US unemployment rate (Adj. r2 = 60%). We contrast this to the high level of correlation between point (instantaneous) estimates of per state case fatality rates and the interaction of median age, population density and current unemployment rates (Adj. r2 = 50.2%). To determine whether this is caused by a “race effect,” we then analyze unemployment, race, median age and population density across US states and show that adding the interaction of African American population and unemployment explains 53.5% of the variance in COVID case fatality rates for the alpha and delta variants when considering instantaneous case fatality rate. Interestingly, when the asymptotic case fatality rate is used, the dependence on the African American population disappears, which is consistent with the fact that in the long-run COVID does not discriminate on race, but may discriminate on access to medical care which is highly correlated to employment in the US. The results provide further evidence of the impact inequality can have on case fatality rates in COVID-19 and the impact complex social, health and economic factors can have on patient survival.

Racial-ethnic, gender identity, and sexual orientation disparities in COVID-19-related social and health outcomes: A decomposition analysis

“…While the hardship of young persons and families with children was occasionally discussed in media and policy reports, this finding calls on researchers to take this theme more seriously in scholarly inquiries. On another plane, the finding here also resonates with Griffin et al’s (2023) recent work that explored age as an essential covariate in dissecting racial disparities in COVID-19 mortality, and the broader tradition in demography that foregrounds population composition as a key variable in analyzing social processes.…”

“…While it is possible that this was due to the rarer nature of severe COVID-19, this pattern nonetheless suggests the import of social resource inequalities as an outcome per se in the study of pandemic influences. An extensive literature has indeed documented either the “health-” or “wealth-” pandemic consequences for minority communities ( Griffin et al, 2023 ), and our results make a strong case for such discussions by showing how physical health disparities can be a more conservative—and resource needs a more exhaustive—way of probing structural inequalities vis-à-vis the pandemic.…”

“…An important example is that transgender individuals had higher prevalence of chronic illness and obesity, but these conditions did not significantly explain their gaps against cisgender persons in either outcome. Similarly, many studies looked to working conditions (e.g., essential worker, unemployment) to explain racial-ethnic disparities during the pandemic, with some finding them relevance ( Dalsania et al, 2022 ; Griffin et al, 2023 ) and others that do not ( Lee et al, 2022 ). Yet we established that differences in unemployment rate do matter in statistical testing but the magnitude of its explanatory power was also quite small, explaining between 1 and 5% of the observed disparities.…”