UM study correlates socioeconomic factors with higher COVID case, death rates

Beth LeBlanc
The Detroit News

A University of Michigan study released Friday appears to confirm a trend of higher COVID-19 incidence in socioeconomically disadvantaged areas, a connection identified and tackled by Michigan officials early in the pandemic.

The study refutes descriptions of COVID-19 as the "great equalizer" and instead points to underlying social factors that correlate with higher incidence of contracting the virus and deaths, including household size, environmental influences, English proficiency, socioeconomic status as well as racial and ethnic minority status. 

The report published Friday on JAMA Network Open by Monita Karmakar, Paula Lantz and Renuka Tipimeni largely overlaid the federal Centers for Disease Control and Prevention's Social Vulnerability Index — which catalogs socio-demographic factors that put certain communities at risk for health issues — with county-level COVID-19 data from January to late July 2020. 

Stacie Padget, left, and Jennifer Snedden, right, and a group of Harper University Hospital nurses and family members deliver presents to Jasmine Logan, who is still recovering in December from the effects of COVID-19, and her husband Steven as well as their five children not shown.

"SARS-CoV-2 neither created the conditions for health disparities nor did it reveal previously unrecognized social inequality," the report said. "Rather, this pandemic has exacerbated longstanding racial/ethnic, social, political, and economic inequities in the US to once again ensure that the most marginalized and underresourced communities experience the worst outcomes."

Michigan was one of the first states in the nation to begin collecting data on COVID-19 cases by race and demographics early in the pandemic. By early April, officials saw that the coronavirus was disproportionately affecting African Americans

At that time, at least 40% of those killed by the virus were Black and 35% of those testing positive were African American. Black people account for about 14% of the state's overall population.

From the start of the pandemic through late July, African-American individuals in Michigan accounted for about 31% of the state's cases, according to UM's Friday report.

Through Thursday, African Americans accounted for 12% of Michigan's cases and 23% of its deaths.

The disproportionate impact is likely a result of community-level social factors causing disparities, including structural racism, the researchers argued.

"Communities with socio-environmental conditions, such as crowded housing and reliance on public transportation, are at higher risk of disease transmission owing to difficulty maintaining social distancing," the report said. "Residents of low-income and racial/ethnic minority communities are also more likely to have essential worker occupations, which put them at higher risk of person-to-person SARS-CoV-2 exposure and transmission."

The study found that COVID-19's prevalence didn't depend just on race or ethnic associations but on broader factors such as unemployment, poverty, food insecurity, poor education, lack of insurance, lack of sick leave or lack of access to the internet. Those factors at times drove up cases in counties with rural, predominantly White populations, the report said.

The study recommended targeted COVID-19 treatment and testing, housing and food assistance, public health announcements in multiple languages and coordination with community-based social service announcements. 

"...The profound economic impact of the pandemic, including the stay-at-home orders and other public health emergency policies necessary to contain SARS-CoV-2, will likely only exacerbate inequities in the social determinants of health," the report said. 

When the disproportionate impact of the pandemic was recognized in April, Gov. Gretchen Whitmer and Lt. Gov. Garlin Gilchrist created the Michigan Task Force on Racial Disparities, which studied the higher incidence and attempted to address it through public health campaigns, increased and strategic testing, more access to primary care providers and telehealth, and improved data quality on cases and deaths. 

Cases and deaths among African Americans dipped as those initiatives took hold and knowledge of the virus's impact on certain populations grew. 

The number of cases between March and October among African Americans dropped from 176 cases per million people per day to 59 cases per million people per day, according to a December task force report.

Likewise, deaths dropped between April and October from 21.7 deaths per million people per day to 1 death per million people per day.