White Counties Stand Apart: The Primacy of Residential Segregation in COVID-19 and HIV Diagnoses

Abstract

Emerging epidemiological data suggest that white Americans have a lower risk of acquiring COVID-19. Although many studies have pointed to the role of systemic racism in COVID-19 racial/ethnic disparities, few studies have examined the contribution of racial segregation. Residential segregation is associated with differing health outcomes by race/ethnicity for various diseases, including HIV. This commentary documents differing HIV and COVID-19 outcomes and service delivery by race/ethnicity and the crucial role of racial segregation. Using publicly available Census data, we divide US counties into quintiles by percentage of non-Hispanic white residents and examine HIV diagnoses and COVID-19 per 100,000 population. HIV diagnoses decrease as the proportion of white residents increase across US counties. COVID-19 diagnoses follow a similar pattern: Counties with the highest proportion of white residents have the fewest cases of COVID-19 irrespective of geographic region or state political party inclination (i.e., red or blue states). Moreover, comparatively fewer COVID-19 diagnoses have occurred in primarily white counties throughout the duration of the US COVID-19 pandemic. Systemic drivers place racial minorities at greater risk for COVID-19 and HIV. Individual-level characteristics (e.g., underlying health conditions for COVID-19 or risk behavior for HIV) do not fully explain excess disease burden in racial minority communities. Corresponding interventions must use structural-and policy-level solutions to address racial and ethnic health disparities.

Modeling the impact of racial and ethnic disparities on COVID-19 epidemic dynamics

“…The estimated activity level differences concord with reports that frontline workers, who are unable to engage in physical or social distancing to the same degree as other types of workers, are disproportionately from minority backgrounds [25, 27, 46]. The assortativity we observed in the census data has root causes in many areas, including residential segregation arising from a long history of discriminatory practices [44, 47]. All of these factors highlight the fact that incorporating heterogeneity in models in a mechanism-free manner can conceal the disparities that underlie changes in epidemic final sizes and HITs.…”

“…Across all model variants, the observed higher cumulative incidence among Hispanics or Latinos and non-Hispanic Black people compared to non-Hispanic whites led to estimates of higher estimated activity levels relative to non-Hispanic whites, mirroring existing inequities in housing, education, healthcare, and beyond [20, 38, 44, 45]. The estimated activity level differences concord with reports that frontline workers, who are unable to engage in physical or social distancing to the same degree as other types of workers, are disproportionately from minority backgrounds [25, 27, 46].…”

COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State

“…This finding parallels increased levels of HIV diagnosis in NYS for persons of color 18 and may reflect the association of differential rates of COVID-19–enhancing comorbidities among persons living with diagnosed HIV of color and/or social and behavioral determinants of health associated with COVID-19 transmission in minority communities. 34 , 35 , 36 , 37 …”

COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

“… 2 SLE is more prevalent and severe in ancestrally African and Hispanic patients, which overlaps with high-risk groups associated with poor outcomes of COVID-19, although the association with the latter may be mediated more by social determinants of health as opposed to biologic factors. 3 , 4 , 5 , 6 In contrast, SLE is a female-predominant disease which may represent a protective factor, as COVID-19 has been shown to affect males more severely. 3 , 7 , 8 , 9 , 10 One interesting feature is that inflammation in SLE is often characterized by elevation of type I interferon (IFN), which has antiviral properties and could potentially be protective.…”