States with the highest level of income inequality had a larger number of COVID-19-related deaths compared with states with lower income inequality. New York state, with the highest income inequality, had a mortality rate of 51.7 deaths per 100,000. This is 125 times greater than Utah, the state with the lowest income inequality and which had a mortality of 0.41 per 100,000 at the end of the period studied. Looking at the top three in each category, New York was followed by Louisiana with 19 deaths per 100,000, and Connecticut with 16.9 deaths per 100,000. States in addition to Utah with the lowest COVID deaths that were linked to income inequality were South Dakota, with 0.7 deaths per 100,000 and North Dakota, which had one death per 100,000.
As the COVID-19 pandemic continues, data from New York City and Chicago shows that African Americans and Hispanics have experienced higher rates of infection and death. These groups are largely low income, have less access to health care, hold essential jobs limiting their ability to maintain social distancing, and frequently live in extended family households where the infection risk is higher.
The researchers limited their analysis to January 22 through April 13, 2020. They used data on cases and deaths from the COVID-19 Dashboard maintained by the Center for Systems Science and Engineering at Johns Hopkins University. State income inequality data came from the 2018 American Community Survey as measured by the Gini index, a statistical formula used to measure income distribution.
The authors note some limitations in the findings, such as the effect of co-morbidities on death rates and weaknesses in state-level data that might have missed other associations between inequality and COVID-19 infections.
The findings suggest that social factors such as income inequality may explain why some states experienced more COVID-19 deaths than others. The findings could be useful in developing policies to mitigate the effects of the pandemic on socio-economically vulnerable populations.
Dr. Carlos Oronce, Dr. Christopher Scannell, and Dr. Yusuke Tsugawa of UCLA, and Dr. Ichiro Kawachi of Harvard University. Oronce and Scannell also have positions with the VA Greater Los Angeles Healthcare System.
The study is published by the peer-reviewed Journal of General Internal Medicine.
Drs. Oronce and Scannell are supported by the VA Office of Academic Affiliations through the VA/National Clinician Scholars Program.