The Unequal Burden of COVID-19 Deaths in Counties With High Proportions of Black and Hispanic Residents.
The Unequal Burden of COVID-19 Deaths in Counties With High Proportions of Black and Hispanic Residents.
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DOI：
10.1097/mlr.0000000000001522
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发表时间：
2021-06-01
期刊：
影响因子：
3
通讯作者：
Dick AW
中科院分区：
文献类型：
--
作者：
Glance LG;Thirukumaran CP;Dick AW
了解弱势人群当前的COVID-19死亡负担将有助于政策制定者为解决COVID-19结果差异所做的努力提供信息。研究COVID-19死亡与非西班牙裔黑人和西班牙裔居民的县级比例之间的关联。回顾性研究使用来自美国事实的COVID-19死亡率数据，与来自美国人口普查局、卫生资源和服务管理局地区卫生资源文件和美国人口普查局的数据相关联。使用负二项回归估计连续30天间隔内县COVID-19死亡总数与非西班牙裔黑人和西班牙裔居民比例之间的关联，调整居民人口统计学，共同负担，农村，健康的社会决定因素和医疗保健资源。4月份，黑人超过40%的县（n=179）的死亡率比黑人少于2%的县（n=1521）高6倍（IRR 6.58; 95% CI：3.29-13.2，p<.001）。这些县在10月之前的死亡率较高，但与11月的参考县没有什么不同。今年4月，西班牙裔居民超过40%的县的死亡率与西班牙裔居民不到2%的县的死亡率相似。这些县的死亡率在8月达到峰值（IRR 3.14，95% CI：1.69-5.82，p<0.001），但在11月也与参考县没有差异。这些影响是强大的调整后，县级特征。在8月之前，死亡率因保险状况而略有不同，但从那时起，未保险率超过15%的县的死亡率比未保险率低于5%的县高出两倍（IRR 1.97，95% CI：1.19-3.27，p<.001）。在大流行期间，非西班牙裔黑人高度集中的县受到COVID-19的影响不成比例，但健康的其他社会决定因素，如医疗保险，现在比种族和民族发挥更突出的作用。
Understanding the current burden of COVID-19 deaths in vulnerable populations will help inform efforts by policymakers to address disparities in COVID-19 outcomes. To examine the association between COVID-19 deaths and the county-level proportions of non-Hispanic Black and Hispanic residents. Retrospective study using COVID-19 mortality data from USA Facts linked to data from the U.S. Census Bureau, the Health Resources & Services Administration Area Health Resources file, and the U.S. Census Bureau. Negative binomial regression was used to estimate the association between the total county COVID-19 deaths during consecutive 30-day intervals and the proportion of non-Hispanic Blacks and Hispanic residents after adjusting for resident demographics, comorbidity burden, rurality, social determinants of health, and healthcare resources. In April, counties (n=179) with more than 40% Blacks had 6-fold higher death rates than counties (n=1521) with fewer than 2% Blacks (IRR 6.58; 95% CI: 3.29–13.2, p<.001). These counties had higher death rates until October, but were no different than referent counties in November. In April, death rates in counties with more than 40% Hispanic residents were similar to death rates in counties with fewer than 2% Hispanic residents. Death rates in these counties peaked in August (IRR 3.14, 95% CI: 1.69–5.82, p<.001) but were also no different than referent counties in November. These effects were robust after adjusting for county-level characteristics. Before August, death rates differed little by insurance status, but since then, counties with more than 15% uninsurance rates had up to two-fold higher mortality rates (IRR 1.97, 95% CI: 1.19–3.27, p<.001) than counties with less than 5% uninsurance rates. Counties with high concentrations of non-Hispanic Blacks were disproportionately affected by COVID-19 throughout most of the pandemic, but other social determinants of health such as health insurance are now playing a more prominent role than race and ethnicity.