Racial, Economic, and Health Inequality and COVID-19 Infection in the United States
Racial, Economic, and Health Inequality and COVID-19 Infection in the United States
复制标题
DOI：
10.1101/2020.04.26.20079756
复制
发表时间：
2020-09-01
影响因子：
3.9
通讯作者：
Zand, Ramin
中科院分区：
文献类型：
--
作者：
Abedi, Vida;Olulana, Oluwaseyi;Zand, Ramin
有初步证据表明，在感染和死于COVID-19的人群中存在种族和社会经济差异。本研究的目的是报告COVID-19与美国种族、健康和经济不平等之间的关联。方法对来自七个疫情最严重的州（密歇根州、纽约州、新泽西州、宾夕法尼亚州、加利福尼亚州、路易斯安那州、马萨诸塞州）的369个县（总人口为102,178,117[中位数为73,447；IQR为30,761-256,098]）的COVID-19感染和死亡率与人口统计学、社会经济和流动性变量之间的关系进行了生态学研究。结果感染和死亡的危险因素不同。我们的分析表明，人口结构更多样化、人口、教育、收入水平更高、残疾率更低的县感染COVID-19的风险更高。然而，残疾率和贫困率较高的县死亡率较高。非洲裔美国人比其他族裔更容易感染COVID-19（非洲裔美国人感染病例为1981例，白人感染病例为658例）。关于流动性变化的数据证实了社交距离的影响。我们的研究提供了COVID-19感染和死亡人群中种族、经济和健康不平等的证据。这些观察结果可能是由于基本服务的劳动力、贫困和获得护理的机会。更多城市地区的县可能在提供医疗服务方面装备更好。在贫困率和残疾率较高的县，感染率较低，但死亡率较高，这可能是由于流动性较低，但合并症和医疗保健可及性较高。
Objectives There is preliminary evidence of racial and social economic disparities in the population infected by and dying from COVID-19. The goal of this study is to report the associations of COVID-19 with respect to race, health, and economic inequality in the United States. Methods We performed an ecological study of the associations between infection and mortality rate of COVID-19 and demographic, socioeconomic, and mobility variables from 369 counties (total population, 102,178,117 [median, 73,447; IQR, 30,761-256,098]) from the seven most affected states (Michigan, New York, New Jersey, Pennsylvania, California, Louisiana, Massachusetts). Results The risk factors for infection and mortality are different. Our analysis shows that counties with more diverse demographics, higher population, education, income levels, and lower disability rates were at a higher risk of COVID-19 infection. However, counties with higher proportion with disability and poverty rates had a higher death rate. African Americans were more vulnerable to COVID-19 than other ethnic groups (1981 African American infected cases versus 658 Whites per million). Data on mobility changes corroborate the impact of social distancing. Conclusion Our study provides evidence of racial, economic, and health inequality in the population infected by and dying from COVID-19. These observations might be due to the workforce of essential services, poverty, and access to care. Counties in more urban areas are probably better equipped at providing care. The lower rate of infection, but a higher death rate in counties with higher poverty and disability could be due to lower levels of mobility, but a higher rate of comorbidities and health care access.