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  • COVID-19-related state-wise racial and ethnic disparities across the USA: an observational study based on publicly available data from The COVID Tracking Project

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Epidemiology
Original research
COVID-19-related state-wise racial and ethnic disparities across the USA: an observational study based on publicly available data from The COVID Tracking Project
  1. Zhaoying Xian1,
  2. Anshul Saxena2,
  3. Zulqarnain Javed1,
  4. John E Jordan3,4,
  5. Safa Alkarawi5,
  6. Safi U Khan6,
  7. Karan Shah7,
  8. Farhaan S Vahidy1,
  9. Khurram Nasir1,
  10. Prachi Dubey1
  1. 1Houston Methodist Hospital, Houston, Texas, USA
  2. 2Baptist Health South Florida, Coral Gables, Florida, USA
  3. 3Radiology, Providence Little Company of Mary Medical Center Torrance, Torrance, California, USA
  4. 4Radiology, Stanford University School of Medicine, Stanford, California, USA
  5. 5Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  6. 6Internal Medicine, West Virginia University, Morgantown, West Virginia, USA
  7. 7Strake Jesuit College Preparatory School, Houston, Texas, USA
  1. Correspondence to Dr Prachi Dubey; pdubey{at}houstonmethodist.org

Abstract

Objective To evaluate COVID-19 infection and mortality disparities in ethnic and racial subgroups in a state-wise manner across the USA.

Methods Publicly available data from The COVID Tracking Project at The Atlantic were accessed between 9 September 2020 and 14 September 2020. For each state and the District of Columbia, % infection, % death, and % population proportion for subgroups of race (African American/black (AA/black), Asian, American Indian or Alaska Native (AI/AN), and white) and ethnicity (Hispanic/Latino, non-Hispanic) were recorded. Crude and normalised disparity estimates were generated for COVID-19 infection (CDI and NDI) and mortality (CDM and NDM), computed as absolute and relative difference between % infection or % mortality and % population proportion per state. Choropleth map display was created as thematic representation proportionate to CDI, NDI, CDM and NDM.

Results The Hispanic population had a median of 158% higher COVID-19 infection relative to their % population proportion (median 158%, IQR 100%–200%). This was followed by AA, with 50% higher COVID-19 infection relative to their % population proportion (median 50%, IQR 25%–100%). The AA population had the most disproportionate mortality, with a median of 46% higher mortality than the % population proportion (median 46%, IQR 18%–66%). Disproportionate impact of COVID-19 was also seen in AI/AN and Asian populations, with 100% excess infections than the % population proportion seen in nine states for AI/AN and seven states for Asian populations. There was no disproportionate impact in the white population in any state.

Conclusions There are racial/ethnic disparities in COVID-19 infection/mortality, with distinct state-wise patterns across the USA based on racial/ethnic composition. There were missing and inconsistently reported racial/ethnic data in many states. This underscores the need for standardised reporting, attention to specific regional patterns, adequate resource allocation and addressing the underlying social determinants of health adversely affecting chronically marginalised groups.

  • epidemiology
  • health policy
  • COVID-19

Data availability statement

Data are available in a public, open access repository. Publicly available data from 'The COVID Tracking Project at The Atlantic' were compiled between 10 September 2020 and 14 September 2020 for this study (https://covidtracking.com/race/dashboard). The data also included information regarding racial and ethnic composition of US states and the District of Columbia derived from US Census Bureau’s 2018 5-year estimates. The COVID Tracking Project at The Atlantic’s data and website content are published under a Creative Commons CC BY 4.0 licence (CC BY 4.0).

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-048006

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    Data availability statement

    Data are available in a public, open access repository. Publicly available data from 'The COVID Tracking Project at The Atlantic' were compiled between 10 September 2020 and 14 September 2020 for this study (https://covidtracking.com/race/dashboard). The data also included information regarding racial and ethnic composition of US states and the District of Columbia derived from US Census Bureau’s 2018 5-year estimates. The COVID Tracking Project at The Atlantic’s data and website content are published under a Creative Commons CC BY 4.0 licence (CC BY 4.0).

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    Footnotes

    • Contributors Data compilation and verification: ZX, SA, KS. Statistical analyses: AS, PD. Manuscript preparation: ZX, ZJ, JEJ, SUK, FSV, KN, PD. Study conception and design: KN, PD.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.