%0 Journal Article
%T Assessing Racial/Ethnic Differences in U.S. County-Level COVID-19 Mortality: Mediation by Socioeconomic Factors and Temporal Changes in the First Year
%A Monica R. Alvarez
%A Diego S. Fuentes
%A Laura M. Ortega
%J International Journal of Social and Psychological Aspects of Healthcare
%@ 3108-4818
%D 2024
%V 4
%N 1
%R 10.51847/EIJhFNG3Jm
%P 161-179
%X Extensive evidence shows that COVID-19 morbidity and mortality in the United States have been unevenly distributed across racial and ethnic groups, with minority populations experiencing disproportionately severe outcomes. This study revisits the role of race and ethnicity in shaping COVID-19 mortality during the first year of the pandemic. Using county-level data and an ecological regression design, the analysis contributes in two key ways. First, it quantifies the association between racial/ethnic composition and COVID-19 mortality for all major racial and ethnic groups at four distinct stages of the pandemic, allowing for an examination of how disparities changed over time. Second, it evaluates whether these associations persist after adjusting for basic socioeconomic factors (SEF), thereby shedding light on potential pathways underlying observed disparities. County racial and ethnic composition is measured using both continuous indicators (population shares) and categorical indicators capturing racial/ethnic plurality. The results demonstrate that counties with larger proportions of non-Hispanic Black, non-Hispanic American Indian and Alaska Native (AIAN), and Hispanic residents experienced higher COVID-19 mortality rates, though the magnitude and consistency of the associations varied across groups. The strongest and most persistent relationships were observed for Black and AIAN populations. Incorporating SEF into the models yielded divergent effects across groups. Among Hispanic populations, socioeconomic conditions largely explained the observed mortality differences. For Black populations, adjustment for SEF reduced but did not eliminate the association [a 1-standard deviation increase in Black population share corresponded to 62–6% higher mortality; mortality was 2.3–1.1 times greater in counties where Blacks constituted a plurality]. In contrast, the association for AIAN populations was minimally attenuated and, in some cases, strengthened [a 44–10% increase in mortality for a 1-standard deviation increase in AIAN share; mortality was 6.2–1.8 times higher in AIAN plurality counties]. Across all racial and ethnic groups, disparities in mortality generally narrowed as the pandemic progressed through its first year.
%U https://smerpub.com/article/assessing-racialethnic-differences-in-us-county-level-covid-19-mortality-mediation-by-socioecono-r9hcs1d3ua8ew2e