OBJECTIVES: Several states in the northeast US are disproportionately burdened by Covid-19 compared to the rest of the country, yet the reasons for this disparity remain unclear. We hypothesized that race may partly contribute to this Covid-19 burden. The purpose of this community-level study was to determine the independent relationship between race and Covid-19 infection rates at the US epicenter.

METHODS: Using data from the US Centers for Disease Control and Prevention on April 28, 2020, we obtained the total number of confirmed Covid-19 cases from each county in 3 US states (Massachusetts, New Jersey, New York) at the Covid-19 epicenter. Covid-19 infection rates in each county were calculated as the number of confirmed cases per 1000 population. The percentage of minority (non-white) residents in each county was categorized by tertile. The primary analysis weighted each county by population size, compared Covid-19 infection rates by minority tertile, and controlled for factors derived from the US Census Bureau including age, sex, socioeconomic status, and population density (a surrogate for social distancing capacity).

RESULTS: Among 35.2 million individuals residing in 97 counties in the 3 US states, the covariate-adjusted rate of Covid-19 infection was 9.5, 12.4, and 14.1 per 1000 population among low, middle, and high minority tertiles (p<0.001 for all comparisons). Similar trends were observed for each minority individually where the Covid-19 infection rate by increasing minority tertile was 8.0, 11.9, and 14.5 per 1000 for Blacks, 4.6, 8.4, and 15.5 per 1000 for Asians, and 4.8, 6.3, and 16.9 per 1000 for Hispanics (p<0.001 for all pairwise tertile comparisons).

CONCLUSIONS: US counties at the Covid-19 epicenter with a higher proportion of racial minority residents have increased Covid-19 infection rates that are independent of demographic and socioeconomic influences. Healthcare policies related to Covid-19 should address communities with high racial minority populations.