While the U.S. has experienced more than 534,000 deaths from COVID-19 as of March 2021, this burden has not been experienced equally by all racial/ethnic groups.* Although many papers have suggested that structural racism is a critical factor in explaining racial disparities in COVID-19 mortality, only a few have demonstrated this link by actually measuring structural racism, and none have done it at the state level or taken age distribution into account, even though age is the most important predictor of death from COVID-19.

Understanding racial disparities at the state level is critical, since states have the primary responsibility for preventing and addressing incidences of COVID-19, along with any racial disparities related to the disease. A recent study published in the Journal of Racial and Ethnic Health Disparities examined the relationship between structural racism and racial disparities in COVID-19 mortality.

What researchers did

The research team downloaded data regarding confirmed COVID-19 deaths from February 2, 2020 through November 28, 2020 from the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics. 

They calculated both crude (defined by the World Bank as the number of deaths occurring during the year in a specific location) and age-adjusted COVID-19 death rates for the non-Hispanic White and non-Hispanic Black populations in 35 U.S. states (which account for 97.8% of the national non-Hispanic Black population), stratifying the data by age, race, and both age and race. 

With these results, the researchers applied a state-level structural racism index that took into consideration:

• Residential segregation 
• Incarceration  
• Economic status 
• Employment status
• Education

They also accounted for three factors identified in previous studies as possible contributors to racial disparities in COVID-19 mortality, namely: 

• Exposure based on occupation
• The presence of underlying medical conditions
• Access to healthcare

What they found

Crude death rate ratios resulted in a substantial underestimation of Black–White disparity in COVID-19 mortality rates. In eight states, for example, the crude death rates suggested that there was either no disparity, or that the Black population was dying from COVID-19 at a lower rate than the White population. 

After adjusting for age, the COVID-19 death rate for the Black population in all eight states was shown to be higher than that for the White population Additionally, the Black–White disparity in COVID-19 deaths was significantly greater in all 35 states when comparing age-adjusted rates to crude rates. 

The five states with the highest disparity ratios were:

Michigan (4.5) 

New York (3.3) 

Minnesota (3.2) 

Florida (3.0) 

Pennsylvania (3.0) 

The five states with the highest racism index were:

Wisconsin (72.3) 

New Jersey (66.3) 

Minnesota (62.6) 

Illinois (61.0)

Connecticut (60.3) 

Scatterplot results showed a pattern of increasing racial disparity that was in line with the increasing state-level structural racism index. The highest Black–White COVID-19 mortality rate disparities occurred in the upper Midwest and Northeast, the regions with the highest structural racism scores.

What it means

The findings demonstrate a significant relationship between state-level structural racism and Black–White disparities in COVID-19 death rates. It is likely that neither treatment and exposure management at the individual level, nor improving access to the healthcare system will be adequate for eliminating racial disparities in COVID-19-related mortality. 

“These findings suggest that the only way to fully address the consequences of structural racism is to dismantle structural racism itself,” explains Michael Siegel, lead author of the study. That means structural changes in economic and political power systems are required in order to achieve health equity. 

The authors also acknowledged that, while the study specifically examined Black–White differences in COVID-19 mortality, other racial-ethnic groups, such as Hispanics, non-Hispanic American Indian/Alaska Natives, and non-Hispanic Asian/Pacific Islanders, also experience a disproportionate burden of COVID-19 disease and death, and deserve attention, as well. 

*Siegel, M., Critchfield-Jain, I., Boykin, M., Owens, A. (2021, Apr. 27). Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 35 US States and Their Association with Structural Racism. Journal of Racial and Ethnic Health Disparities. https://link.springer.com/article/10.1007/s40615-021-01028-1

Much about the novel coronavirus, i.e., COVID-19, is still not fully understood. As research progresses and our knowledge of the virus increases, information can change rapidly. We strive to update all of our articles as quickly as possible, but there may occasionally be some lag between scientific developments and our revisions.