The Magnitude of Black/Hispanic Disparity in COVID-19 Mortality Across United States Counties During the First Waves of the COVID-19 Pandemic

Objectives: To quantify the Black/Hispanic disparity in COVID-19 mortality in the United States (US). Methods: COVID-19 deaths in all US counties nationwide were analyzed to estimate COVID-19 mortality rate ratios by county-level proportions of Black/Hispanic residents, using mixed-effects Poisson regression. Excess COVID-19 mortality counts, relative to predicted under a counterfactual scenario of no racial/ethnic disparity gradient, were estimated. Results: County-level COVID-19 mortality rates increased monotonically with county-level proportions of Black and Hispanic residents, up to 5.4-fold (>= 43% Black) and 11.6-fold (>= 55% Hispanic) higher compared to counties with <5% Black and <15% Hispanic residents, respectively, controlling for county-level poverty, age, and urbanization level. Had this disparity gradient not existed, the US COVID-19 death count would have been 92.1% lower (177,672 fewer deaths), making the rate comparable to other high-income countries with substantially lower COVID-19 death counts. Conclusion: During the first 8 months of the SARS-CoV-2 pandemic, the US experienced the highest number of COVID-19 deaths. This COVID-19 mortality burden is strongly associated with county-level racial/ethnic diversity, explaining most US COVID-19 deaths.