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Substantial health disparities exist across race/ethnicity in the USA, with Black Americans often most affected. The current COVID-19 pandemic is no different. While there have been ample studies describing racial disparities in COVID-19 outcomes, relatively few have established an empirical link between these disparities and structural racism. Such empirical analyses are critically important to help defuse “victim-blaming” narratives about why minority communities have been badly hit by COVID-19. In this paper, we explore the empirical link between structural racism and disparities in county-level COVID-19 outcomes by county racial composition. Using negative binomial regression models, we examine how five measures of county-level residential segregation and racial disparities in socioeconomic outcomes as well as incarceration rates are associated with county-level COVID-19 outcomes. We find significant associations between higher levels of measured structural racism and higher rates of COVID-19 cases and deaths, even after adjusting for county-level population sociodemographic characteristics, measures of population health, access to healthcare, population density, and duration of the COVID-19 outbreak. One percentage point more Black residents predicted a 1.1% increase in county case rate. This association decreased to 0.4% when structural racism indicators were included in our model. Similarly, one percentage point more Black residents predicted a 1.8% increase in county death rates, which became non-significant after adjustment for structural racism. Our findings lend empirical support to the hypothesis that structural racism is an important driver of racial disparities in COVID-19 outcomes, and reinforce existing calls for action to address structural racism as a fundamental cause of health disparities. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40615-020-00948-8.
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?:doi
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10.1007/s40615-020-00948-8
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J_Racial_Ethn_Health_Disparities
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document_parses/pdf_json/ce9efd1d7c0acb5140ec4f9ead387bc450c0112e.json; document_parses/pdf_json/293467fb68fe95ce526979e43d4fc67cc128a638.json
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document_parses/pmc_json/PMC7815192.xml.json
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Structural Racism and COVID-19 in the USA: a County-Level Empirical Analysis
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