Structural Racism and COVID-19 in the USA: a County-Level Empirical Analysis

被引:118
作者
Tan, Shin Bin [1 ,2 ]
DeSouza, Priyanka [1 ]
Raifman, Matthew [3 ]
机构
[1] MIT, Dept Urban Studies & Planning, Cambridge, MA 02139 USA
[2] Natl Univ Singapore, Lee Kuan Yew Sch Publ Policy, Singapore, Singapore
[3] Boston Univ, Sch Publ Hlth, Dept Environm Hlth, Boston, MA USA
关键词
Race; COVID-19; Structural racism; Residential segregation; disparities; BLACK-AND-WHITE; RESIDENTIAL SEGREGATION; FUNDAMENTAL CAUSE; HEALTH; DISPARITIES; RACE; DISCRIMINATION; ASSOCIATION; INEQUITIES; INEQUALITY;
D O I
10.1007/s40615-020-00948-8
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
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.
引用
收藏
页码:236 / 246
页数:11
相关论文
共 63 条
[1]  
Abramovitz M., 2020, FAM SOC
[2]   Invited Commentary: Residential Segregation and Health-The Complexity of Modeling Separate Social Contexts [J].
Acevedo-Garcia, Dolores ;
Osypuk, Theresa L. .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 2008, 168 (11) :1255-1258
[3]   Why inequality could spread COVID-19 [J].
Ahmed, Faheem ;
Ahmed, Na'eem ;
Pissarides, Christopher ;
Stiglitz, Joseph .
LANCET PUBLIC HEALTH, 2020, 5 (05) :E240-E240
[4]  
Anderson KathrynFreeman., 2018, SOCIAL SCI, V7, P119, DOI [10.3390/socsci7080119, DOI 10.3390/SOCSCI7080119]
[5]  
[Anonymous], 2020, US COR CAS DEATHS
[6]   Structural racism and health inequities in the USA: evidence and interventions [J].
Bailey, Zinzi D. ;
Krieger, Nancy ;
Agenor, Madina ;
Graves, Jasmine ;
Linos, Natalia ;
Bassett, Mary T. .
LANCET, 2017, 389 (10077) :1453-1463
[7]  
Barber S., 2020, COVID 19 CONTEXT RAC
[8]  
Barr D.A., 2019, Health Disparities in the United States: Social Class, Race, Ethnicity, and the Social Determinants of Health
[9]  
Bassett M., 2020, Harvard Center for Population and Development Studies Working Paper Series, V19
[10]   Fitting Linear Mixed-Effects Models Using lme4 [J].
Bates, Douglas ;
Maechler, Martin ;
Bolker, Benjamin M. ;
Walker, Steven C. .
JOURNAL OF STATISTICAL SOFTWARE, 2015, 67 (01) :1-48