A Study of Cumulative COVID-19 Mortality Trends Associated with Ethnic-Racial Composition, Income Inequality, and Party Inclination among US Counties.

This research analyzes the association between cumulative COVID-19 mortality and ethnic-racial composition, income inequality, and political party inclination across counties in the United States. The study extends prior research by taking a long view-examining cumulative mortality burdens over the first 900 days of the COVID-19 pandemic at five time points (via negative binomial models) and as trajectories of cumulative mortality trends (via growth curve models). The analysis shows that counties with a higher Republican vote share display a higher cumulative mortality, especially over longer periods of the pandemic. It also demonstrates that counties with a higher composition of ethnic-racial minorities, especially Blacks, bear a much higher cumulative mortality burden, and such an elevated burden would be even higher when a county has a higher level of income inequality. For counties with a higher proportion of Hispanic population, while the burden is lower than that for counties with a higher proportion of Blacks, the cumulative COVID-19 mortality burden still is elevated and compounded by income inequality, at any given time point during the pandemic.

Social and economic inequality in coronavirus disease 2019 vaccination coverage across Illinois counties.

Prior research has well established the association of ethno-racial and economic inequality with COVID-19 incidence and mortality rates across counties in the US. In this ecological study, a similar association was found between ethno-racial and economic inequality and COVID-19 full vaccination rates across the 102 counties in the American state of Illinois in the early months of vaccination. Among the counties with income inequality below the median, a county's poverty rate had a negative association with the proportion of population fully vaccinated. However, among the counties with income inequality above the median, a higher percentage of Black or Hispanic population was persistently associated with a lower proportion of fully vaccinated population over the two-month period from early February to early April of 2021.

Association of Social and Economic Inequality With Coronavirus Disease 2019 Incidence and Mortality Across US Counties.

Importance: It is now established that across the United States, minoritized populations have borne a disproportionate burden from coronavirus disease 2019 (COVID-19). However, little is known about the interaction among a county's racial/ethnic composition, its level of income inequality, political factors, and COVID-19 outcomes in the population. Objective: To quantify the association of economic inequality, racial/ethnic composition, political factors, and state health care policy with the incidence and mortality burden associated with COVID-19. Design, Setting, and Participants: This cross-sectional study used data from the 3142 counties in the 50 US states and for Washington, DC. Data on the first 200 days of the COVID-19 pandemic, from the first confirmed US case on January 22 to August 8, 2020, were gathered from the Centers for Disease Control and Prevention and USAFacts.org, the US Census Bureau, the American Community Survey, GitHub, the Kaiser Family Foundation, the Council of State Governments, and the National Governors Association. Exposures: Racial/ethnic composition was determined as percentage of the population that is Black or Hispanic; income inequality, using the Gini index; politics, political affiliation and sex of the state governor, gubernatorial term limits, and percentage of the county's population that voted Republican in 2016; and state health care policy, participation in the expansion of Medicaid under the Affordable Care Act. Six additional covariates were assessed. Main Outcomes and Measures: Cumulative COVID-19 incidence and mortality rates for US counties during the first 200 days of the pandemic. Main measures include percentage Black and Hispanic population composition, income inequality, and a set of additional covariates. Results: This study included 3141 of 3142 US counties. The mean Black population was 9.365% (range, 0-86.593%); the mean Hispanic population was 9.754% (range, 0.648%-96.353%); the mean Gini ratio was 44.538 (range, 25.670-66.470); the proportion of counties within states that implemented Medicaid expansion was 0.577 (range, 0-1); the mean number of confirmed COVID-19 cases per 100 000 population was 1093.882 (range, 0-14 019.852); and the mean number of COVID-19-related deaths per 100 000 population was 26.173 (range, 0-413.858). A 1.0% increase in a county's income inequality corresponded to an adjusted risk ratio (RR) of 1.020 (95% CI, 1.012-1.027) for COVID-19 incidence and adjusted RR of 1.030 (95% CI, 1.012-1.047) for COVID-19 mortality. Inequality compounded the association of racial/ethnic composition through interaction, with higher income inequality raising the intercepts of the incidence curve RR by a factor of 1.041 (95% CI, 1.031-1.051) and that of the mortality curve RR by a factor of 1.068 (95% CI, 1.042-1.094) but slightly lowering their curvatures, especially for Hispanic composition. When state-level specificities were controlled, none of the state political factors were associated with COVID-19 incidence or mortality. However, a county in a state with Medicaid expansion implemented would see the incidence rate RR decreased by a multiplicative factor of 0.678 (95% CI, 0.501-0.918). Conclusions and Relevance: This county-level ecological analysis suggests that COVID-19 surveillance systems should account for county-level income inequality to better understand the social patterning of COVID-19 incidence and mortality. High levels of income inequality may harm population health irrespective of racial/ethnic composition.