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Whites’ County-Level Racial Bias, COVID-19 Rates, and Racial Inequities in the United States

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  • Marilyn D. Thomas

    (Department of Epidemiology and Biostatistics, School of Medicine, University of California, 550 16th St 2nd floor, San Francisco, CA 94158, USA
    Department of Psychiatry, School of Medicine, University of California, 1001 Potrero Ave, San Francisco, CA 94110, USA)

  • Eli K. Michaels

    (Division of Epidemiology, School of Public Health, University of California, 2121 Berkeley Way, Room 5302, Berkeley, CA 94720, USA)

  • Sean Darling-Hammond

    (Goldman School of Public Policy, University of California, 2607 Hearst Ave, Berkeley, CA 94720, USA)

  • Thu T. Nguyen

    (Department of Family and Community Medicine, School of Medicine, University of California, 995 Potrero Ave, San Francisco, CA 94110, USA)

  • M. Maria Glymour

    (Department of Epidemiology and Biostatistics, School of Medicine, University of California, 550 16th St 2nd floor, San Francisco, CA 94158, USA)

  • Eric Vittinghoff

    (Department of Epidemiology and Biostatistics, School of Medicine, University of California, 550 16th St 2nd floor, San Francisco, CA 94158, USA)

Abstract

Mounting evidence reveals considerable racial inequities in coronavirus disease 2019 (COVID-19) outcomes in the United States (US). Area-level racial bias has been associated with multiple adverse health outcomes, but its association with COVID-19 is yet unexplored. Combining county-level data from Project Implicit on implicit and explicit anti-Black bias among non-Hispanic Whites, Johns Hopkins Coronavirus Resource Center, and The New York Times , we used adjusted linear regressions to estimate overall COVID-19 incidence and mortality rates through 01 July 2020, Black and White incidence rates through 28 May 2020, and Black–White incidence rate gaps on average area-level implicit and explicit racial bias. Across 2994 counties, the average COVID-19 mortality rate (standard deviation) was 1.7/10,000 people (3.3) and average cumulative COVID-19 incidence rate was 52.1/10,000 (77.2). Higher racial bias was associated with higher overall mortality rates (per 1 standard deviation higher implicit bias b = 0.65/10,000 (95% confidence interval: 0.39, 0.91); explicit bias b = 0.49/10,000 (0.27, 0.70)) and higher overall incidence (implicit bias b = 8.42/10,000 (4.64, 12.20); explicit bias b = 8.83/10,000 (5.32, 12.35)). In 957 counties with race-specific data, higher racial bias predicted higher White and Black incidence rates, and larger Black–White incidence rate gaps. Anti-Black bias among Whites predicts worse COVID-19 outcomes and greater inequities. Area-level interventions may ameliorate health inequities.

Suggested Citation

  • Marilyn D. Thomas & Eli K. Michaels & Sean Darling-Hammond & Thu T. Nguyen & M. Maria Glymour & Eric Vittinghoff, 2020. "Whites’ County-Level Racial Bias, COVID-19 Rates, and Racial Inequities in the United States," IJERPH, MDPI, vol. 17(22), pages 1-19, November.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:22:p:8695-:d:449635
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    References listed on IDEAS

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    Cited by:

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    2. Lonnie R. Snowden, 2023. "US states' racial bias correlates with less SNAP participation by “undeserving poor” adults and lower unemployment benefit maximums," Poverty & Public Policy, John Wiley & Sons, vol. 15(2), pages 133-149, June.
    3. Jay J. Xu & Jarvis T. Chen & Thomas R. Belin & Ronald S. Brookmeyer & Marc A. Suchard & Christina M. Ramirez, 2021. "Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia," IJERPH, MDPI, vol. 18(6), pages 1-29, March.
    4. Qiang Niu & Wanxian Wu & Jie Shen & Jiaxin Huang & Qiling Zhou, 2021. "Relationship between Built Environment and COVID-19 Dispersal Based on Age Stratification: A Case Study of Wuhan," IJERPH, MDPI, vol. 18(14), pages 1-17, July.

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