COVID‐19 Death Rates Are Higher in Rural Counties With Larger Shares of Blacks and Hispanics

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Abstract

This study compared the average daily increase in COVID-19 mortality rates by county racial/ethnic composition (percent non-Hispanic [NH] Black and percent Hispanic) among U.S. rural counties. COVID-19 daily death counts for 1,976 U.S. nonmetropolitan counties for the period March 2-July 26, 2020 were extracted from USAFacts and merged with county-level American Community Survey and Area Health Resource File data. Covariates included county percent poverty, age composition, adjacency to a metropolitan county, health care supply, and state fixed effects. Mixed-effects negative binomial regression with random intercepts to account for repeated observations within counties was used to predict differences in the average daily increase in the COVID-19 mortality rate across quartiles of percent Black and percent Hispanic. Since early March, the average daily increase in the COVID-19 mortality rate has been significantly higher in rural counties with the highest percent Black and percent Hispanic populations. Compared to counties in the bottom quartile, counties in the top quartile of percent Black have an average daily increase that is 70% higher (IRR=1.70, CI=1.48 to 1.95, P<0.001), and counties in the top quartile of percent Hispanic have an average daily increase that is 50% higher (IRR=1.50, CI=1.33 to 1.69, P <.001), net of covariates. COVID-19 mortality risk is not distributed equally across the rural U.S., and the COVID-19 race penalty is not restricted to cities. Among rural counties, the average daily increase in COVID-19 mortality rates has been significantly higher in counties with the largest shares of Black and Hispanic residents.

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Most cited references 17

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Assessing Differential Impacts of COVID-19 on Black Communities

Gregorio Millett, Austin T. Jones, David Benkeser … (2020)

Purpose Given incomplete data reporting by race, we used data on COVID-19 cases and deaths in US counties to describe racial disparities in COVID-19 disease and death and associated determinants. Methods Using publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (>13%) black and all other ( 13% black residents. Conclusions Nearly twenty-two percent of US counties are disproportionately black and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally. County-level comparisons can both inform COVID-19 responses and identify epidemic hot spots. Social conditions, structural racism, and other factors elevate risk for COVID-19 diagnoses and deaths in black communities.

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Disparities in diabetes: the nexus of race, poverty, and place.

Darrell Gaskin, Roland Thorpe, Emma Mcginty … (2014)

We sought to determine the role of neighborhood poverty and racial composition on race disparities in diabetes prevalence. We used data from the 1999-2004 National Health and Nutrition Examination Survey and 2000 US Census to estimate the impact of individual race and poverty and neighborhood racial composition and poverty concentration on the odds of having diabetes. We found a race-poverty-place gradient for diabetes prevalence for Blacks and poor Whites. The odds of having diabetes were higher for Blacks than for Whites. Individual poverty increased the odds of having diabetes for both Whites and Blacks. Living in a poor neighborhood increased the odds of having diabetes for Blacks and poor Whites. To address race disparities in diabetes, policymakers should address problems created by concentrated poverty (e.g., lack of access to reasonably priced fruits and vegetables, recreational facilities, and health care services; high crime rates; and greater exposures to environmental toxins). Housing and development policies in urban areas should avoid creating high-poverty neighborhoods.

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Widening rural-urban disparities in life expectancy, U.S., 1969-2009.

Gopal Singh, Mohammad Siahpush (2014)

There is limited research on rural-urban disparities in U.S. life expectancy. This study examined trends in rural-urban disparities in life expectancy at birth in the U.S. between 1969 and 2009. The 1969-2009 U.S. county-level mortality data linked to a rural-urban continuum measure were analyzed. Life expectancies were calculated by age, gender, and race for 3-year time periods between 1969 and 2004 and for 2005-2009 using standard life-table methodology. Differences in life expectancy were decomposed by age and cause of death. Life expectancy was inversely related to levels of rurality. In 2005-2009, those in large metropolitan areas had a life expectancy of 79.1 years, compared with 76.9 years in small urban towns and 76.7 years in rural areas. When stratified by gender, race, and income, life expectancy ranged from 67.7 years among poor black men in nonmetropolitan areas to 89.6 among poor Asian/Pacific Islander women in metropolitan areas. Rural-urban disparities widened over time. In 1969-1971, life expectancy was 0.4 years longer in metropolitan than in nonmetropolitan areas (70.9 vs 70.5 years). By 2005-2009, the life expectancy difference had increased to 2.0 years (78.8 vs 76.8 years). The rural poor and rural blacks currently experience survival probabilities that urban rich and urban whites enjoyed 4 decades earlier. Causes of death contributing most to the increasing rural-urban disparity and lower life expectancy in rural areas include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, and diabetes. Between 1969 and 2009, residents in metropolitan areas experienced larger gains in life expectancy than those in nonmetropolitan areas, contributing to the widening gap. Published by American Journal of Preventive Medicine on behalf of American Journal of Preventive Medicine.