Disparities in COVID-19 mortality by county racial composition and the role of spring social distancing measures.
Disparities in COVID-19 mortality by county racial composition and the role of spring social distancing measures.
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DOI：
10.1016/j.ehb.2020.100953
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发表时间：
2021-05
影响因子：
2.5
通讯作者：
Hamman MK
中科院分区：
文献类型：
--
作者：
Hamman MK
现有的COVID-19数据显示，美国黑人的病例和死亡比例较高，但按种族报告的数据很差。本文采用非线性回归分解法研究了黑人人口比例高于和低于全国平均水平的县之间的县级死亡率差异，并估计了社会距离措施的潜在差异影响。我发现黑人人口比例高于全国人口比例的县的死亡率比其他县高2到3倍。生活条件、健康和工作特征的可观察差异将总体差异降低至约1.25至1.65，并解释了首例病例后21天的100%差异。虽然黑人人口比例较高的县的合并症发病率较高是一个重要的预测因素，但单亲和人口密度等生活状况因素也同样重要。与孙辈共同居住的比例较高，解释了21天差异的11%，但到42天时似乎并不重要，这表明家庭在疫情后期可能能够更好地保护脆弱的家庭成员。要分析社会距离措施的不同效果，使用两种方法。首先，我利用干预措施的时间相对于第一个病例的县，开始在同一时间的流行。其次，我使用事件研究分析来分析县内死亡率的变化。社会距离措施的调查结果并不总是一致的方法。总的来说，我没有发现任何证据表明，在黑人人口比例较大的县，学校关闭的效果较差，一些估计表明，关闭学校可能不成比例地帮助了更多样化的县和祖父母和孙子孙女共同居住率高的县。相反，在任何县，呆在家里的命令与死亡率的关系都不太明显，在任何模型中，达到失业高峰并没有降低死亡率，一些估计表明，在第一个病例之前达到失业高峰与更高的死亡率有关，特别是在更多样化的县。
Available COVID-19 data shows higher shares of cases and deaths occur among Black Americans, but reporting of data by race is poor. This paper investigates disparities in county-level mortality rates across counties with higher and lower than national average Black population shares using nonlinear regression decomposition and estimates potential differential impact of social distancing measures. I find counties with Black population shares above the national share have mortality rates 2 to 3 times higher than in other counties. Observable differences in living conditions, health, and work characteristics reduce the disparity to approximately 1.25 to 1.65 overall, and explain 100% of the disparity at 21 days after the first case. Though higher rates of comorbidities in counties with higher Black population shares are an important predictor, living situation factors like single parenthood and population density are just as important. Higher rates of co-residence with grandchildren explain 11% of the 21 day disparity but do not appear important by 42 days, suggesting families may have been better able to protect vulnerable family members later in the epidemic. To analyze differential effects of social distancing measures use two approaches. First, I exploit the timing of interventions relative to the first case among counties that began their epidemic at the same time. Second, I use event study analysis to analyze within-county changes in mortality. Findings for social distancing measures are not always consistent across approaches. Overall, I find no evidence that school closures were less effective in counties with larger Black population shares, and some estimates suggest closures may have disproportionately helped more diverse counties and counties with high rates of grandparent and grandchild co-residence. Conversely, stay at home orders are less clearly associated with mortality in any counties, reaching peak unemployment did not reduce mortality in any models, and some estimates indicate reaching peak unemployment before the first case was associated with higher mortality rates, especially in more diverse counties.
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