Racial Disparities in Coronavirus Disease 2019 (COVID-19) Mortality Are Driven by Unequal Infection Risks

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Abstract

Background

As of 1 November 2020, there have been >230 000 deaths and 9 million confirmed and probable cases attributable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States. However, this overwhelming toll has not been distributed equally, with geographic, race/ethnic, age, and socioeconomic disparities in exposure and mortality defining features of the US coronavirus disease 2019 (COVID-19) epidemic.

Methods

We used individual-level COVID-19 incidence and mortality data from the state of Michigan to estimate age-specific incidence and mortality rates by race/ethnic group. Data were analyzed using hierarchical Bayesian regression models, and model results were validated using posterior predictive checks.

Results

In crude and age-standardized analyses we found rates of incidence and mortality more than twice as high than for Whites for all groups except Native Americans. Blacks experienced the greatest burden of confirmed and probable COVID-19 (age-standardized incidence, 1626/100 000 population) and mortality (age-standardized mortality rate, 244/100 000). These rates reflect large disparities, as Blacks experienced age-standardized incidence and mortality rates 5.5 (95% posterior credible interval [CrI], 5.4–5.6) and 6.7 (95% CrI, 6.4–7.1) times higher than Whites, respectively. We found that the bulk of the disparity in mortality between Blacks and Whites is driven by dramatically higher rates of COVID-19 infection across all age groups, particularly among older adults, rather than age-specific variation in case-fatality rates.

Conclusions

This work suggests that well-documented racial disparities in COVID-19 mortality in hard-hit settings, such as Michigan, are driven primarily by variation in household, community, and workplace exposure rather than case-fatality rates.

Article activity feed

  1. SciScore for 10.1101/2020.09.10.20192369: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Software: All analyses were completed in R 3.6.3, using the rstanarm package16 for Bayesian regression analysis, the tidybayes package for post-processing17 and ggplot2 for visualization.
    ggplot2
    suggested: (ggplot2, RRID:SCR_014601)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Nonetheless, there are some limitations that are important to highlight. First, our reliance …
  2. Our take

    This is a prospective study, available as a preprint and thus not yet peer reviewed, using case level data on 49,701 confirmed and probable cases of SARS-CoV-2 from Michigan, United States. Investigators found that racial minorities (except for Native Americans) had higher incidence and mortality rates compared to whites. The similarity in case fatality rates among racial groups suggests that greater exposure to the virus may be driving excess deaths in racial minority groups compared to whites. This could be indicative of various factors such as higher population density or a lack of ability to socially distance due to a higher number of essential workers in these communities. A major limitation is that the study does not include other variables (e.g. markers of socioeconomic status (SES) or neighborhood level SES) …