Socioeconomic and Racial Segregation and COVID-19: Concentrated Disadvantage and Black Concentration in Association with COVID-19 Deaths in the USA

Abstract

Introduction This study's objective was to examine the association of the percentage of county population residing in concentrated disadvantage and Black-concentrated census tracts with county-level confirmed COVID-19 deaths in the USA, concentrated disadvantage and Black concentration at census tract-level measure socioeconomic segregation and racial segregation, respectively. Methods We performed secondary data analysis using tract (N = 73,056) and county (N = 3142) level data from the US Census Bureau and other sources for the USA. Confirmed COVID-19 deaths per 100,000 population was our outcome measure. We performed mixed-effect negative binomial regression to examine the association of county population's percentage residing in concentrated disadvantage and Black-concentrated tracts with COVID-19 deaths while controlling for several other characteristics. Results For every 10% increase in the percentage of county population residing in concentrated disadvantage and Black-concentrated tracts, the rate for confirmed COVID-19 deaths per 100,000 population increases by a factor of 1.14 (mortality rate ratio [MMR] = 1.14; 95% confidence interval [CI]:1.11, 1.18) and 1.11 (MMR = 1.11; 95% CI:1.08, 1.14), respectively. These relations stayed significant in all models in further sensitivity analyses. Moreover, a joint increase in the percentage of county population residing in racial and socioeconomic segregation was associated with a much greater increase in COVID-19 deaths. Conclusions It appears that people living in socioeconomically and racially segregated neighborhoods may be disproportionately impacted by COVID-19 deaths. Future multilevel and longitudinal studies with data at both individual and aggregated tract level can help isolate the potential impacts of the individual-level characteristics and neighborhood-level socioeconomic and racial segregation with more precision and confidence.

Is the cure really worse than the disease? The health impacts of lockdowns during COVID-19

“…It is also important to emphasise the health equity perspective in this discussion. There is a strong interrelationship between disadvantage and the risk of death from COVID-19, 43 and this is also likely to be true of government interventions against the disease. Where possible, governments should provide support for individuals impacted by both COVID-19 and lockdowns because, regardless of whether the disease runs rampant, the human cost will not be insignificant.…”

Racial/Ethnic Residential Segregation and the First Wave of SARS-CoV-2 Infection Rates: A Spatial Analysis of Four U.S. Cities

“…As it relates to the literature on COVID-19 specifically, a growing body of work has begun to examine how racial/ethnic residential segregation contributes to racial disparities in COVID-19 transmission and deaths, and these results largely track with these early findings ( Hawkins 2020 ; Khanijahani and Tomassoni 2021 ; Kim and Bostwick 2020 ; Millet et al 2020 ; Rogers et al 2020 ; Selden and Berdahl 2020 ; Tan et al 2020 ; Yang et al 2021 ; Yu et al 2021 ). These studies display robust results that show that the features of racially segregated areas exacerbate the transmission and effects of the COVID-19 disease.…”

“…However, these studies have limitations that we hope our analyses can address. First, many studies only examine segregation at the county level, which is a large geographic unit of analysis that cannot measure more neighborhood-level effects of segregation ( Khanijahani and Tomassoni 2021 ; Millet et al 2020 ; Tan et al 2020 ; Yang et al 2021 ; Yu et al 2021 ). By using zip-code-level data, we are able to better account for these fine-grained dimensions of segregation and take into account both the concentration and clustering of racial/ethnic minorities.…”

“…By using zip-code-level data, we are able to better account for these fine-grained dimensions of segregation and take into account both the concentration and clustering of racial/ethnic minorities. Next, several studies only use COVID-19 deaths in their analyses, which does not as accurately capture the mechanisms we hope to test ( Khanijahani and Tomassoni 2021 ; Kim and Bostwick 2020 ; Yu et al 2021 ). While the conditions of racially segregated areas may contribute to an increased probability of dying from COVID-19, we argue that looking at total infections better captures the prevalence and transmission of SARS-CoV-2 in these areas, as well as better captures how the risk factors in segregated areas affect the people at risk of infection, beyond mortality.…”

“…In addition, several recent studies on the spread of COVID-19 analyzing residential segregation specifically also point to racial segregation as a contributor to the discrepancy of infection rates among racial and ethnic minorities ( Khanijahani and Tomassoni 2021 ; Tan, deSouza, and Raifman 2020 ; Yang, Choi, and Sun 2021 ; Yu et al 2021 ). For instance, Yu and colleagues (2021) found black and Latino segregated areas to have a faster growth rate of COVID-19 infections and deaths.…”