The Relationship between Systemic Racism, Residential Segregation, and Racial/Ethnic Disparities in COVID-19 Deaths in the United States.

Introduction:Although Black Americans are not substantially more likely to be diagnosed with COVID-19, hospitalization rates and death rates are considerably higher than for White Americans. The aim of this study was to assess the relationship between systemic racism generally, and residential segregation in particular, and racial/ethnic disparities in deaths due to COVID-19. Methods:To assess racial disparities in COVID-19 and systemic racism in US states, we calculated descriptive statistics and bivariate Pearson correlations. Using data on deaths through December 2020, we developed a weighted logistic mixed model to assess whether state-level systemic racism generally and residential segregation, in particular, predicted the probability of COVID-19 deaths among Americans, considering key sociodemographic factors. Results:Residential segregation is a stronger predictor of COVID-19 deaths among Black Americans, as compared to systemic racism more generally. Looking at the interaction between residential segregation and COVID-19 death rates by race, residential segregation is associated with negative outcomes for Black and White Americans, but disproportionately impacts Black state residents (P<.001), who have 2.14 times higher odds of dying from COVID-19 when residential segregation is increased. Conclusion:To understand and address disparities in infectious disease, researchers and public health practitioners should acknowledge how different forms of systemic racism shape health outcomes in the United States. More attention should be given to the mechanisms by which infectious disease pandemics exacerbate health disparities in areas of high residential segregation and should inform more targeted health policies. Such policy changes stand to make all American communities more resilient in the face of new and emerging infectious diseases.