Consistently lower rates of COVID-19 and HIV in predominantly white counties across the United States are driven by factors such as residential segregation, structural racism, and social determinants of health, an analysis by amfAR, The Foundation for AIDS Research finds.
Published in the medical journal AIDS Patient Care and STDs and based on data from the U.S. Census Bureau, USAFacts, and the New York Times, the study found that, as of August 2, the 22 percent of counties with an "above average" percentage of African-American residents accounted for 45 percent of coronavirus cases and 51 percent of deaths from COVID-19. According to the analysis, the higher the proportion of white residents in a county, the lower the seven-day moving average of confirmed COVID-19 diagnoses per hundred thousand residents. The study also found that during the recent surge of cases across the South and West, infection rates remained lowest in counties with the highest proportion of white residents, while falling rates of COVID-19 in the Northeast and Midwest were driven mainly by the decline in cases among racially diverse counties, and that rates remained low and stable in Northeastern and Midwestern counties with the greatest concentrations of white residents both before and after the lifting of state-imposed lockdowns.
The study includes an interactive map showing confirmed COVID-19 cases and deaths by county and state as reported by local public health agencies, alongside three "structural" factors: the percentage of residents experiencing poverty, the percentage of those without health insurance, and the unemployment rate. For instance, in Michigan's Wayne County, where just under half the population is white (49.6 percent) and which had a poverty rate of 23.05 percent, an uninsured rate of 8.25 percent, and an unemployment rate of 4.65 percent, the seven-day average for COVID cases and deaths as of August 10 was 28,273 and more than 2,800, respectively. By comparison, in neighboring Monroe County, where 91.38 percent of residents are white and the poverty rate is 10.62 percent, the uninsured rate is 5.57 percent, and the unemployment rate is 11.93 percent, the seven-day averages for cases and deaths were 987 and 26.
"Neither luck nor genetics keep COVID-19 diagnoses lower in mainly white counties and higher in primarily non-white counties," said Greg Millett, vice president and director of public policy at amfAR. "Adapting programmatic and policy interventions that have worked for HIV may help, but the historic legacy of residential segregation and redlining will have an enduring effect on health disparities until we decide to fix it."
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