Racial and Ethnic Disparities in COVID-19 Cases in Hotspot Counties, February–June 2020

This page summarizes a CDC analysis published in August 2020, early in the COVID-19 pandemic.

By August 10, 2020, about 5 million COVID-19 cases had been reported in the United States. State and national data already suggested that people of color were more likely to be infected with SARS-CoV-2, to become seriously ill, and to die. CDC looked at whether those disparities showed up in hotspot counties — counties flagged by thresholds on the number of new cases and the change in incidence.

How disparities were measured

During June 5–18, 2020, 205 counties in 33 states were identified as hotspots, home to 93.5 million people and about 535,000 cumulative cases. The analysis included only counties that reported race for at least half their cases: 79 counties in 22 states, with 27.5 million people and about 162,000 cases.

For each underrepresented racial or ethnic group in each county, a disparity meant that the group's share of cases exceeded its share of the population by 5 percentage points or more, or that its share of cases was at least 1.5 times its share of the population. Because many cases lacked race data, the researchers simulated different assumptions about those cases to test their results. Cumulative case counts from February to June were used, since too few cases during the two hotspot weeks had race data.

Findings

Disparities appeared in 76 of the 79 counties (96.2%).

Across counties with disparities, the average gap between a group's share of cases and its share of population ranged from 4.5 percentage points for Native Hawaiian and Pacific Islander residents to 39.3 for American Indian and Alaska Native residents, and the average ratio from 2.3 for Black residents to 8.5 for Native Hawaiian and Pacific Islander residents.

Hispanic people were the largest group living in hotspot counties where their community was disproportionately affected, consistent with other evidence. The findings for Black residents matched well-documented overrepresentation in cases, hospitalizations and deaths. Few counties showed disparities among American Indian and Alaska Native people, probably because of their smaller numbers in these counties and problems with data, including gaps in surveillance and misclassification.

Why disparities arise

The authors point to conditions that raise exposure to the virus: structural factors such as economic and housing policies and the built environment; work as essential employees who must be on site, in meatpacking, agriculture, service jobs and health care; living in multigenerational or multifamily households; and overrepresentation in crowded group living settings. Long-standing discrimination and social inequities can also raise the risk of severe illness and death, through limited access to health care, underlying medical conditions, and greater exposure to pollution and environmental hazards. Deaths could not be analyzed because county-level mortality data by race were too sparse.

What could help

Identifying disproportionately affected groups at the county level can guide resources, culturally and linguistically tailored prevention and focused testing. The authors called for interventions developed with trusted leaders and community organizations, more complete collection of race and ethnicity data, and long-term investment in communities of color to address the social determinants of health and structural racism.

Limitations

• More than half of hotspot counties lacked enough race data, and included counties were missing race for an average of 28.3% of cases.
• Health departments report race and ethnicity differently, and collection methods (self-report or observation) vary.
• Unequal access to testing may understate cases in some groups.
• Cumulative counts describe the whole period, not necessarily the hotspot weeks.

Sources

• Jazmyn T. Moore, Jessica N. Ricaldi, Charles E. Rose and colleagues, with the COVID-19 State, Tribal, Local, and Territorial Response Team, "Disparities in Incidence of COVID-19 Among Underrepresented Racial/Ethnic Groups in Counties Identified as Hotspots During June 5–18, 2020 — 22 States, February–June 2020," Morbidity and Mortality Weekly Report, CDC: https://www.cdc.gov/mmwr/volumes/69/wr/mm6933e1.htm