Geographic Variation of Racial Disparities in Health and COVID-19 Mortality

Parcha, Vibhu; Malla, Gargya; Suri, Sarabjeet S.; Kalra, Rajat; Heindl, Brittain; Berra, Lorenzo; Fouad, Mona N.; Arora, Garima; Arora, Pankaj

Objective To evaluate the race-stratified state-level prevalence of health determinants and the racial disparities in coronavirus disease-2019 (COVID-19) cumulative incidence and mortality in the United States. Patients and Methods Age-adjusted race-stratified prevalence of comorbidities (hypertension, diabetes, dyslipidemia, obesity), preexisting medical conditions (pulmonary disease, heart disease, stroke, kidney disease, malignancy), poor health behaviors (smoking, alcohol abuse, physical inactivity), and adverse socioeconomic factors (education, household income, health insurance) was computed in 435,139 American adult participants from 2017 Behavioral Risk Factor Surveillance System survey (BRFSS). Correlation was assessed between health determinants and the race-stratified COVID-19 crude mortality and infection-fatality-ratio computed from respective state public health departments in 47 states. Results Blacks had a higher prevalence of comorbidities (63.3% [95%CI:62.4-64.2%] vs. 55.1% [95%CI:54.7-55.5]) and adverse socioeconomic factors (47.0% [95%CI:46.0-47.9%] vs. 30.9% [95%CI:30.6-31.3]) than Whites. The prevalence of preexisting medical conditions was similar among Blacks (30.4% [95%CI:28.8-32.1%]) and Whites (30.8% [95%CI:30.2-31.4%]). The prevalence of poor health behaviors was higher in Whites (57.2% [95%CI:56.3-58.0%]) than Blacks (50.2% [95%CI:46.2-54.2%]). The comorbidities and adverse socioeconomic factors were highest in the Southern region, and poor health behaviors were highest in the Western region. Cumulative incidence rate (per 100,000 persons) was three-fold higher in Blacks (1546.4) compared withwith Whites (540.4). The crude mortality (per 100,000 persons) was two-fold higher in Blacks (83.2) than Whites (33.2). However, the infection-fatality-ratio (per 100-cases) was similar between Whites (6.2) and Blacks (5.4). Within racial groups, the geographic distribution of health determinants did not correlate with state-level COVID-19 mortality and infection-fatality ratio (p>0.05 for all). Conclusions Racial disparities in COVID-19 are largely driven by the higher cumulative incidence of infection in Blacks. There is a discordance between the geographic dispersion of COVID-19 mortality and the regional distribution of health determinants.