ABSTRACT
Background: To assess the effect of population-based age, race, gender, ethnicity, settlement type, health coverage and poverty on coronavirus disease-19 (COVID-19) death rate during the exponential increase period. Methods: The study involved ecological analysis of publicly available COVID-19 cases and deaths data for January-May 2020. Using Boltzmann fitting of COVID-19 cases and deaths, the inflection time, duration and rate of the exponential increase period were computed. The associations of COVID-19 deaths rate with COVID-19 cases rate and population estimates of race, ethnicity, age, gender, living in urban settlements, uninsured and poverty levels were assessed using multivariate regression analysis. Results: The exponential increase period lasted on average 49.2 and 43.6 for COVID-19 cases and deaths, respectively. The corresponding rates during the same period were 55.8±7.5 and 3.3±0.6 per 1,000,000 per day. Both the duration and rate of the COVID-19 cases during the exponential increase period increased as the percent and race and ethnic minorities, male and elderly increased. An increase of 69% (95% CI: -6 to 144) and 51% (95% CI: -33 to 134) of COVID-19 rate for an interquartile range increase in the percentage of older than 45 years and minorities was computed. Gender, settlement type, health insurance and poverty were also positively associated with COVID-19 death rate during the exponential increase period. Conclusions: The study highlighted that race/ethnicity and socioeconomic status may modify the relationship between COVID-19 disease and mortality. © 2021 AME Publishing Company. All rights reserved.