The Relationship Between Social Determinants of Health and Racial Disparities in COVID-19 Mortality

TLDR

The COVID‑19 pandemic has amplified health disparities in the U.S., especially for Black Americans, with social determinants of health identified as key drivers of these inequities. This study aimed to quantify how county‑level social determinants of health are associated with COVID‑19 mortality and racial disparities in death rates. Using negative binomial regression on publicly available county data through October 2020, the authors examined the relationship between social determinants and mortality, noting that higher death rates coincided with larger Black populations and worse socioeconomic conditions. Each one‑percentage‑point increase in Black residents, uninsured adults, low birth‑weight, lack of high‑school diploma, incarceration, or no‑internet households raised death rates by 0.9–7.6 %, while counties in the lowest economic‑privilege quintile had 67.5 % higher mortality; multivariate analysis indicated these factors partially explain racial disparities.

Abstract

The COVID-19 pandemic has magnified existing health disparities for marginalized populations in the United States (U.S.), particularly among Black Americans. Social determinants of health are powerful drivers of health outcomes that could influence COVID-19 racial disparities.We collected data from publicly available databases on COVID-19 death rates through October 28, 2020, clinical covariates, and social determinants of health indicators at the U.S. county level. We utilized negative binomial regression to assess the association between social determinants of health and COVID-19 mortality focusing on racial disparities in mortality.Counties with higher death rates had a higher proportion of Black residents and greater levels of adverse social determinants of health. A one percentage point increase in percent Black residents, percent uninsured adults, percent low birthweight, percent adults without high school diploma, incarceration rate, and percent households without internet in a county increased COVID-19 death rates by 0.9% (95% CI 0.5%-1.3%), 1.9% (95% CI 1.1%-2.7%), 7.6% (95% CI 4.4%-11.0%), 3.5% (95% CI 2.5%-4.5%), 5.4% (95% CI 1.3%-9.7%), and 3.4% (95% CI 2.5%-4.2%), respectively. Counties in the lowest quintile of a measure of economic privilege had an increased COVID-19 death rates of 67.5% (95% CI 35.9%-106.6%). Multivariate regression and subgroup analyses suggested that adverse social determinants of health may partially explain racial disparities in COVID-19 mortality.This study demonstrates that social determinants of health contribute to COVID-19 mortality for Black Americans at the county level, highlighting the need for public health policies that address racial disparities in health outcomes.