Counties With High COVID-19 Incidence and Relatively Large Racial and Ethnic Minority Populations

United States, April 1-December 22, 2020

Florence C. Lee, MPH; Laura Adams, DVM; Sierra J. Graves, MPH; Greta M. Massetti, PhD; Renee M. Calanan, PhD; Ana Penman-Aguilar, PhD; S. Jane Henley, MSPH; Francis B. Annor, PhD; Michelle Van Handel, MPH; Noah Aleshire, JD; Tonji Durant, PhD; Jennifer Fuld, PhD; Sean Griffing, PhD; Laura Mattocks, MPH; Leandris Liburd, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2021;70(13):483-489. 

In This Article

Abstract and Introduction

Introduction

Long-standing systemic social, economic, and environmental inequities in the United States have put many communities of color (racial and ethnic minority groups) at increased risk for exposure to and infection with SARS-CoV-2, the virus that causes COVID-19, as well as more severe COVID-19–related outcomes.[1–3] Because race and ethnicity are missing for a proportion of reported COVID-19 cases, counties with substantial missing information often are excluded from analyses of disparities.[4] Thus, as a complement to these case-based analyses, population-based studies can help direct public health interventions. Using data from the 50 states and the District of Columbia (DC), CDC identified counties where five racial and ethnic minority groups (Hispanic or Latino [Hispanic], non-Hispanic Black or African American [Black], non-Hispanic Asian [Asian], non-Hispanic American Indian or Alaska Native [AI/AN], and non-Hispanic Native Hawaiian or other Pacific Islander [NH/PI]) might have experienced high COVID-19 impact during April 1–December 22, 2020. These counties had high 2-week COVID-19 incidences (>100 new cases per 100,000 persons in the total population) and percentages of persons in five racial and ethnic groups that were larger than the national percentages (denoted as "large"). During April 1–14, a total of 359 (11.4%) of 3,142 U.S. counties reported high COVID-19 incidence, including 28.7% of counties with large percentages of Asian persons and 27.9% of counties with large percentages of Black persons. During August 5–18, high COVID-19 incidence was reported by 2,034 (64.7%) counties, including 92.4% of counties with large percentages of Black persons and 74.5% of counties with large percentages of Hispanic persons. During December 9–22, high COVID-19 incidence was reported by 3,114 (99.1%) counties, including >95% of those with large percentages of persons in each of the five racial and ethnic minority groups. The findings of this population-based analysis complement those of case-based analyses. In jurisdictions with substantial missing race and ethnicity information, this method could be applied to smaller geographic areas, to identify communities of color that might be experiencing high potential COVID-19 impact. As areas with high rates of new infection change over time, public health efforts can be tailored to the needs of communities of color as the pandemic evolves and integrated with longer-term plans to improve health equity.

To assess potential COVID-19 impact on racial and ethnic minority groups, CDC examined two population-based measures: incidence of COVID-19 at the county level during three successive 2-week periods during April 1–December 22, 2020, and the percentage of the county population accounted for by each racial and ethnic minority group. Two-week COVID-19 incidence was calculated as numbers of cases[5] per 100,000 persons collected from state and local health department websites*; counties with >100 new cases per 100,000 persons during the 2-week period were considered to have high incidence.

The percentage of county population represented by five racial and ethnic minority groups was calculated using 2019 U.S. Census population estimates. Counties whose percentage of racial and ethnic minority persons exceeded the 2019 national percentage were considered to have relatively large populations of the respective racial and ethnic minority group. For the Hispanic, Black, Asian, AI/AN, and NH/PI groups, these were percentages in excess of 18.5%, 12.5%, 5.8%, 0.7%, and 0.2%, respectively. Whereas the term "population" is used to describe all persons within a reported race and ethnicity category, the diversity of backgrounds and experiences that exists within these broad groups is recognized.

Counties were considered to have high potential COVID-19 impact during the 2-week period for a racial and ethnic minority group if they had both high COVID-19 incidence and a large population of the respective group. Counties were considered to have relatively low potential COVID-19 impact during the 2-week period for a racial and ethnic minority group if they had a large population of the respective group and low COVID-19 incidence or had a small population of the respective group, regardless of COVID-19 incidence. To illustrate where counties with high potential COVID-19 impact were located for each racial and ethnic minority group, maps were created for three time periods, representing the beginning (April 1–14), middle (August 5–18), and end (December 9–22) of the analysis period (Supplementary Figures 1–3, https://stacks.cdc.gov/view/cdc/104229). In these maps, high COVID-19 incidence was further categorized as >100 to ≤500 and >500 new cases per 100,000 persons. Large population of the respective racial and ethnic minority group was further categorized as >national percentage to ≤upper cutpoint and >upper cutpoint, where the upper cutpoint was determined using Jenks natural breaks.§ The four U.S. Census regions were used to describe groups of counties for interpretation.

During April 1–14, high COVID-19 incidence was reported by 359 (11.4%) counties, most of which were in the Northeast and South (Figure 1). High COVID-19 incidence was reported by 28.7%, 27.9%, 12.5%, 5.1%, and 0.6% of counties with large Asian, Black, Hispanic, AI/AN, and NH/PI populations, respectively, during this period (Table) (Figure 2) (Supplementary Figure 1, https://stacks.cdc.gov/view/cdc/104229).

Figure 1.

Counties with high COVID-19 incidence,* by county for April 1–14, August 5–18, and December 9–22 — United States, April 1–December 22, 2020
*>100 new cases per 100,000 persons in the 2-week period.
U.S. Census regions are outlined in black.

Figure 2.

Percentage of counties with high COVID-19 incidence* among U.S. counties with large population percentages of five racial and ethnic minority groups — United States, April 1–December 22, 2020
Abbreviations: AI/AN = American Indian/Alaska Native; NH/PI = Native Hawaiian or other Pacific Islander.
*>100 new cases per 100,000 persons in the 2-week period.
Percentage of racial and ethnic minority group populations in the county higher than the national percentages: 12.5% (non-Hispanic Black), 18.5% (Hispanic/Latino), 5.8% (non-Hispanic Asian), 0.7% (non-Hispanic AI/AN), and 0.2% (non-Hispanic NH/PI).

As the geographic distribution of counties reporting high COVID-19 incidence changed regionally throughout the course of the U.S. pandemic, the potential COVID-19 impact on each racial and ethnic minority group also changed. During August 5–18, high COVID-19 incidence was reported by 2,034 (64.7%) counties, most of which were in the South (Figure 1). High COVID-19 incidence was reported by 92.4%, 74.5%, 65.9%, 64.7%, and 51.7% of counties with large Black, Hispanic, NH/PI, Asian, and AI/AN populations, respectively, during this period (Table) (Figure 2) (Supplementary Figure 2, https://stacks.cdc.gov/view/cdc/104229). During December 9–22, when 3,114 (99.1%) counties reported high COVID-19 incidence, >95% of counties with large populations of each racial and ethnic minority group reported high COVID-19 incidence (Table) (Figure 2) (Supplementary Figure 3, https://stacks.cdc.gov/view/cdc/104229).

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