Risk for COVID-19 infection and death among Latinos in the United States: Examining heterogeneity in transmission dynamics

Rodriguez-Diaz, Carlos E.; Guilamo-Ramos, Vincent; Mena, Leandro; Hall, Eric; Honermann, Brian; Crowley, Jeffrey S.; Baral, Stefan; Prado, Guillermo J.; Marzan-Rodriguez, Melissa; Beyrer, Chris; Sullivan, Patrick S.; Millett, Gregorio A.

OBJECTIVES: Ascertain COVID-19 transmission dynamics among Latino communities nationally. METHODS: We compared predictors of COVID-19 cases and deaths between disproportionally Latino counties (>17.8% Latino population) and all other counties through May 11, 2020. Adjusted Rate Ratios were estimated using COVID-19 cases and deaths via zero-inflated binomial regression models. RESULTS: COVID-19 diagnoses rates were greater in Latino counties nationally (90.9 vs. 82.0 per 100,000). In multivariable analysis, COVID-19 cases were greater in Northeastern and Midwestern Latino counties (aRR 1.42, 95% CI 1.11–1.84 and aRR 1.70, 95% CI 1.57–1.85, respectively). COVID-19 deaths were greater in Midwestern Latino counties (aRR, 1.17, 95% CI 1.04-1.34). COVID-19 diagnoses were associated with counties with greater monolingual Spanish speakers, employment rates, heart disease deaths, less social distancing, and days since the first reported case. COVID-19 deaths were associated with household occupancy density, air pollution, employment, days since the first reported case, and age (fewer <35yo). CONCLUSIONS: COVID-19 risks and deaths among Latino populations differ by region. Structural factors place Latino populations and particularly monolingual Spanish speakers at elevated risk for COVID-19 acquisition.