Exploring Spatial & Racial Disparities in COVID-19 Mortality
How do social determinants of health help explain inequities in deaths from COVID-19?
By Susan Paykin and Qinyun Lin
US COVID Atlas researchers have been using exploratory spatial data analytic (ESDA) techniques to better understand the disproportionate impacts of the pandemic on communities of color nationwide. We wanted to explore how we might quantify the impact of structural racism on COVID-19 outcomes. This is a complex and difficult phenomenon to measure and quantify, in part because racism shapes and is also shaped by multidimensional factors across interpersonal and structural levels of our society, including healthcare, economic, housing, and education systems. In this post, we provide some background and context for this study.
Existing Evidence on Racial and Spatial Disparities
It is well documented that in the United States, the COVID-19 pandemic has disproportionately affected racial and ethnic minority groups and other marginalized communities. Nationally, COVID-19 has been associated with higher infection and mortality rates in Black, Hispanic/Latinx, and Native American communities across state and regional levels. There is also strong evidence in research focused on specific regions or areas. In California, age-adjusted mortality rates from the first half of 2020 indicate higher COVID-19 mortality rates among Asian American Pacific Islander, Black, and Hispanic persons, with working-age Hispanics facing the highest risk, compared to white persons. In a study of 10 major US metropolitan areas, an excess burden of infections and deaths was experienced by counties with higher percentages of racial minority groups and higher poverty rates. Furthermore, among 79 counties identified as hotspots in June 2020 that also had sufficient data on race, a disproportionate number of COVID-19 cases occurred among underrepresented groups, with Hispanic/Latinx being the largest population group impacted.
Challenges in Quantifying Structural Racism
A significant challenge in quantifying the impact of structural racism on COVID-19 outcomes is that the U.S. CDC does not report race-disaggregated COVID-19 data below the state level. (County-level, race-disaggregated data is made available by some individual counties, but not nation-wide.) While all states have released race-disaggregated mortality data, fewer are reporting data disaggregated by both race and age. State-level estimates can also mask heterogeneous population composition and distribution, making community-level impacts difficult to evaluate. This is particularly true for states with non-white racial and ethnic group populations highly concentrated in a small number of cities or regions. Additionally, the Modifiable Areal Unit Problem (MAUP) in geography highlights issues of different findings produced by different levels of aggregation, while the ecological fallacy also exposes the challenges posed by aggregating individuals to a group.
Additional challenges include the potential heterogeneity experienced by different groups in different contexts (e.g., rural versus urban areas) as well as the contagious nature of the COVID-19 pandemic.
Our Response
Employing an exploratory spatial data analysis approach, we started with two complementary visual analytic techniques, namely co-location analysis and dot density mapping (see one example, above), to identify counties with large populations of racial and ethnic group minority communities and track emerging spatial trends related to high COVID-19 mortality rates. Recognizing that not all groups were experiencing high COVID rates due to the same factors, we then tested the associations of each group and their SDOH influencers across spatial regimes of rural, urban, and suburban counties. Preliminary analyses suggest that the experiences of Black, Latinx and white communities varied widely due to different social determinants in different geographies and spatial regimes. While we continue to refine the analysis, it is clear that equitable policy responses to the pandemic should take these spatial and racial group disparities and differences into account. We look forward to sharing more findings as research progresses.
Research that seeks to quantify the impact of structural racism on health outcomes, especially COVID-19, is critical for furthering racial equity. If you have any questions about the data or methods used in this research or how to understand the changing COVID landscape, reach out to US Covid Atlas on Twitter.
