• Anne H Gaglioti, Chaohua Li, Megan D Douglas, Baltrus Peter T PT, Mitchell A Blount, Rabab Zahidi, Lee S Caplan, Willock Robina Josiah RJ, Omofolarin B Fasuyi, and Dominic H Mack.
• National Center for Primary Care (Dr Gaglioti, Douglas, Baltrus, and Mack, Mr Li, and Mss Blount and Zahidi), Department of Family Medicine (Drs Gaglioti, Fasuyi, and Mack), Department of Community Health and Preventive Medicine (Drs Douglas, Baltrus, Caplan, and Willock), Morehouse School of Medicine, Atlanta, Georgia.
• J Public Health Manag Pract. 2021 May 1; 27 (3): 268-277.

ContextThere is a need to understand population race and ethnicity disparities in the context of sociodemographic risk factors in the US experience of the COVID-19 pandemic.ObjectiveDetermine the association between county-level proportion of non-Hispanic Black (NHB) on county COVID-19 case and death rates and observe how this association was influenced by county sociodemographic and health care infrastructure characteristics.Design And SettingThis was an ecologic analysis of US counties as of September 20, 2020, that employed stepwise construction of linear and negative binomial regression models. The primary independent variable was the proportion of NHB population in the county. Covariates included county demographic composition, proportion uninsured, proportion living in crowded households, proportion living in poverty, population density, state testing rate, Primary Care Health Professional Shortage Area status, and hospital beds per 1000 population.Main Outcome MeasuresOutcomes were exponentiated COVID-19 cases per 100 000 population and COVID-19 deaths per 100 000 population. We produced county-level maps of the measures of interest.ResultsIn total, 3044 of 3142 US counties were included. Bivariate relationships between the proportion of NHB in a county and county COVID-19 case (Exp β = 1.026; 95% confidence interval [CI], 1.024-1.028; P < .001) and death rates (rate ratio [RR] = 1.032; 95% CI, 1.029-1.035; P < .001) were not attenuated in fully adjusted models. The adjusted association between the proportion of NHB population in a county and county COVID-19 case was Exp β = 1.025 (95% CI, 1.023-1.027; P < .001) and the association with county death rates was RR = 1.034 (95% CI, 1.031-1.038; P < .001).ConclusionsThe proportion of NHB people in a county was positively associated with county COVID-19 case and death rates and did not change in models that accounted for other socioecologic and health care infrastructure characteristics that have been hypothesized to account for the disproportionate impact of COVID-19 on racial and ethnic minority populations. Results can inform efforts to mitigate the impact of structural racism of COVID-19.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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