Hot off the press - our research letter arguing that the way CDC reports COVID-19 disparities is misleading. #tweetorial #epitwitter #socialepitwitter
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768722

U.S. CDC does not report mortality rates by race/ethnicity. Instead, the distribution of COVID-19 deaths by race/ethnicity is presented along with a “weighted distribution of the population” (by race) as comparison.

This weighted distribution up-weights people who live in high COVID mortality counties, and down-weights (or outright excludes) people who live in low or no mortality counties.

Why? They argue: “COVID-19 deaths are concentrated in certain geographic locations where the racial and ethnic population distribution differs from that of the United States overall.” We looked at this closely.

If you compare the distribution of covid deaths by race to the weighted population constructed by the CDC, it looks like Black people are under-represented in deaths. (black people were 22% those who died but 18% of the weighted population).

But if you compare the % distribution of COVID-19 deaths to the real US population, it looks like Black people are over-represented in deaths. Which population is the appropriate reference pop?

We argue that the correct ref group is the U.S. population. Why? Because a) COVID-19 disparities are due to racism, not race, and b) racism shapes who gets to live where.

Poorer counties concentrate risk-factors for covid such as % people who are essential service workers, access to insurance, and prevalence of household crowding. Structural racism sorts people into poorer and wealthier places by race.

By excluding wealthier counties with more white people, the CDC ensures that white people with the lowest risk are excluded from the weighted population. Here is a figure showing these weights for New York counties along with pop size and overcrowding. (POC= “people of color”)

This weighting procedure inappropriately adjusts for geographic location - a major pathway through which structural racism shapes health. As a result, it understates the excess burden of COVID-19 mortality among Black, Latinx, and Asian individuals.

Long story short, don’t use the weighted population when examining health disparities. Use the US population.

While we focus on inequities among Asian, Black, and Latinx populations, similar trends have been observed among Native American and Pacific Islander populations
https://khn.org/morning-breakout/cdc-denies-native-american-tribes-requests-for-coronavirus-data-that-is-freely-available-to-states/
https://www.theguardian.com/world/2020/jul/27/system-is-so-broken-covid-19-devastates-pacific-islander-communities-in-us

These groups are often not highlighted in discussions around health inequities given smaller population sizes and issues with undercounting Native American and Native Hawaiian and Pacific Islander groups.

Co-Authors: @ToriCowger @badavis_ @onisha_e, @klts0 Jourdyn Lawrence, @DrMaryTBassett, Dr Nancy Krieger.
With thanks to Dr Jarvis Chen for teaching my classmates and I a lot.