Marked Disparities in COVID-19 Prevalence by Racial/Ethnic, Socioeconomic, Geographic, and Health Care Characteristics, United States, January – April, 2021

Abstract

Background: Since the start of the coronavirus disease (COVID-19) pandemic in March 2020, racial/ethnic minorities and socially-disadvantaged populations in the United States (US) have experienced disproportionately higher rates of COVID-19 incidence, mortality and hospitalization. However, the extent of disparities in the prevalence of COVID-19 diagnosis have not been well-documented. Using nationally representative data, this study examines racial/ethnic, socioeconomic, and geographic inequalities in COVID-19 prevalence among US adults aged ≥18 years. Methods: Using the Census Bureau’s Household Pulse Survey from January 6-April 26, 2021 (N=521,203), social inequalities in COVID-19 prevalence were analyzed by multivariate logistic regression. Results: During January-April 2021, 34.7 million or 14.2% of US adults reported ever being diagnosed with COVID-19. Those aged 18-24 and 45-54 were two times more likely to be diagnosed with COVID-19 than those aged ≥75. Disease prevalence ranged from 10.0% for Asians to 14.2% for Black/African Americans and 23.0% for Hispanics. Controlling for covariates, non-Hispanic Whites, Black/African Americans, and Hispanics had, respectively, 23%, 31%, and 134% higher odds of being diagnosed with COVID-19 than Asians. Educational gradients were marked; adults with less than a high school education had twice the prevalence of COVID-19 than those with a graduate degree (19.0% vs. 9.4%). Controlling for covariates, those with less than high school and high school education had, respectively, 66% and 48% higher odds of being diagnosed with COVID-19 than those with a graduate degree. Those experiencing job/income losses during the pandemic had a significantly increased risk of COVID-19 diagnosis, adjusting for other factors. Prevalence of COVID-19 ranged from a low of 7.4% in Seattle-Tacoma Metropolitan Statistical Area (MSA) to a high of 30.0% in Riverside-San Bernardino MSA. Conclusions and Implications for Translational Research: Black/African Americans, Hispanics, NonHispanic Whites, socially-disadvantaged adults, and those living in Riverside-San Bernardino, Phoenix, Dallas-Fort Worth, and Los Angeles-Long Beach MSAs had substantially higher likelihood of being diagnosed with COVID-19.