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.