|Takuo Aoyagi, an inventor of the pulse oximeter, an ingenious and indispensable medical device that measures oxygen in the blood and has become a staple of hospitals around the world, emerging in recent months as a key tool in the fight against the novel coronavirus, died April 18. He was 84. Washington Post|
This US County health analysis is dedicated to individuals who are the victims of the Covid-19 virus and to all the people working hard to keep our US Counties safe and nourished.
Summary — Data as of May 7, 2020
This analysis uses County statistics to report on public health outcomes relating to the covid-19 crisis. The hope is that this information will help support community investment decisions by Federal and County administrators to improve resident health services and public health. This analysis examines County ethnicity statistics to illustrate their association with covid-19 deaths across 3,142 US Counties.
In summary, Counties with above average White American populations are faring well in the covid-19 crisis. In fact, among the lowest median income US Counties, only 0.1 deaths occur in those with above average White American populations for every single death that occurs in all other low-income Counties. Public health expert guidelines would suggest that better diet and exercise coupled with better health services contribute to these positive outcomes.
On the other hand, Counties with above average Hispanic American and African American populations have had the worst outcomes in the covid-19 crisis. In mid-size population Counties with above average Hispanic American populations 2.0 deaths occur for every single death in other Counties of similar size. Even among America’s highest median income Counties, those with above average African American populations have 3.3 covid-19 deaths for every single death occurring in the other high-income Counties. Most alarmingly, 7.0 deaths occur in above average African American population Counties that have the lowest median incomes for every single death that occurs in all other Counties in the lowest median income band – that is 700% more deaths. According to expert guidance, above average Hispanic American and African American Counties require community investment in parks, nutrition services, hospitals, health clinics, and, very soon, contact tracing if the US wants all Counties to prosper. Resources are required so those that are under-served can take ownership of and sustain their future.
Covid-19 Deaths and Ethnic Percentages for Each State
Prosperity is more complex than just consumption. The covid-19 crisis has proven that a healthy and safe workforce is required to sustain consumer societies. So, can US economists measure our markets and can shareholders value our corporations in ways that account for not just the goods and services they create, but also the value they contribute to sustainable community health outcomes?
Analysis of Covid-19 Deaths
The pandemic has fallen heavily on 6 NY state counties. This especially affects the results of the group of 44 large US metropolitan “A” Counties with 1 million residents or more. They account for 28% of the US population and 47% of covid-19 deaths — for every covid-19 death in the rest of the US 2.2 have occurred in “A” Counties. When New York state is removed the rate of covid-19 deaths is the same for “A” Counties as it is for the rest of US Counties.
However, on removing New York state, another imbalance comes to light. For 228 “B” Counties with between 250,000 to 1 million residents, outside of New York state, 2.1 covid-19 deaths occur for every single death in other US Counties. Many of these trends relate to County ethnicity, but most importantly also to the public health and health resources available to each.
US Population and Covid-19 Deaths by County Size Group
To better understand these imbalances, this analysis begins with the US Counties with the fewest covid-19 deaths which are above average White American population Counties. In the graph below, US Counties are split into two groups with the results for above average White American population Counties highlighted (orange). Above average white population Counties experience 0.3 deaths for every death that occurs in the remaining US Counties. This suggests the above average White American population Counties may be making the kinds of public health and health care investments that the rest of US Counties should consider.
Counties where White Americans are 85% or more of the population (orange)
County median income bands, with roughly 80 million US residents living in each, rank US Counties from high-to-low median income. The highest income US Counties have median income above $73,000. The bottom 25% of Counties have median income below $38,000. The lowest median income Counties are smaller, and range in size from 692 to 424,000 residents. Currently, only 0.1 deaths occur in the lowest median income Counties that have above average White American populations for every single covid-19 death experienced in other low median income Counties. The lowest median income above average White American Counties have been healthiest during the covid-19 crisis.
Counties where White Americans are 85% or more of the population (orange) — ranked by County Median Income band
The relatively few covid-19 deaths in above average White American Counties must be made up for elsewhere. Next we’ll consider Counties with either above average Hispanic American or African American populations. (Note: some Counties qualify in more than one ethnic segmentation of the US population.)
Above average Hispanic American population Counties account for 39% of the US population but 2.1 deaths for every single covid-19 death occurring in the rest of the US. The previously mentioned imbalance in “B” County covid-19 deaths appears in above average Hispanic American populations where 2 deaths occur for every single death in other “B” Counties. When New York state is excluded the results are similar with 1.2 of every covid-19 death occurring in “B” Counties with above average Hispanic American populations.
Counties where Hispanic Americans are 18% or more of the population (orange)
When Counties are ranked from high-to-low median income the rate of covid-19 deaths is consistently higher than their population share would suggest. Even among America’s top median income Counties, those with above average Hispanic American populations experience 1.4 for every single covid-19 deaths that occurs in America’s other high-income Counties.
Counties where Hispanic Americans are 18% or more of the population (orange) — ranked by County Median Income band
Counties with above average African American populations account for 37% of US residents. All things being equal, one would expect the same percent of covid-19 deaths, however, 2.6 deaths occur in above average African American population Counties for every single death in other US Counties. The chart below is a mirror image of what was illustrated above for above average White American Counties where fewer, not larger, than expected covid-19 deaths occur. When New York state is excluded from above average African American population Counties 1.8 deaths occur in for every single death that occurs in other US Counties.
Counties where African Americans are 13% or more of the population (orange)
One may hope that above average African American population Counties with the highest median incomes might at least be safer but they are not. They experience 1.8 deaths for every single death that occurs in the rest of US’s highest median income counties — 80% more covid-19 deaths. But, most alarmingly, 7.0 deaths occur in above average African American population Counties that have the lowest median incomes for every single death that occurs in all other Counties in the lowest median income band – that is 700% more deaths.
Counties where African Americans are 13% or more of the population (orange) — ranked by County Median Income band
It is worth noting that race and ethnicity are defined separately on the US Census so that many Hispanic residents can also report their race. As a result, when population and death figures are combined from this analysis they may end up being larger than the national totals.
Counties with above average White American populations are faring well through the covid-19 crisis. Counties with above average Hispanic American populations, especially “B” Counties, and all above average African American population Counties require more investment if they are to reverse the current trend in covid-19 deaths and improve their public health and health care services in the future.
This is one of a series of analyses that relate covid-19 deaths to key County health and demographic characteristics, such as cancer death rate or percent of adults over 60. Each analysis focuses on Counties where the health or demographic characteristic is higher than some “average”. The “average” is defined here as the characteristic’s incidence or percentage — think of average cancer death rates or percentage of adults over 60 — that accounts for roughly 1/3rd of the US population when the Counties that qualify are pooled together. Covid-19 deaths are then totaled for Counties that come in above or below the “average”.
The resulting 1/3 versus 2/3 population comparison then gets written as a ratio, such as, 0.5 : 1. Of course, the ratios change as the data changes. For example, the ratio helps us compare the covid-19 death rates for Counties with above average percent adults over age 60 to those with below average percent adults over 60. All things being equal, the ratio of covid-19 death rates should match the ratio of the County populations. Typically it won’t: “For Counties with 1 million or more residents, the covid-19 death rate ratio of those with above average percent adults over age 60 to that of the remaining Counties with 1 million or more residents is 1.2 : 1. In other words, residents living in Counties with above average percent adults age over 60 have a 20% higher chance of a covid-19 death than residents living in the remaining Counties that have 1 million+ population. They are younger.”
Here’s an example. First, the covid-19 death rate is computed by the covid-19 deaths divided by population. For the entire US, as of today, the covid-19 death rate is 0.02% = 80,140 / 325,719,178, meaning 2 out of 10,000 residents have died. Next, we create the covid-19 death rate ratio by comparing the death rates of the Counties with and without the characteristic. In this example, the 1.2 : 1 ratio reported for “A” Counties with above average percent adults age over 60 is the ratio of covid-19 death rates of the with the characteristic and those without, or, in this case, 1.2 = (3,522 /7,585,831) / (33,043/ 85,069,756). The 1.2 represents the numerator, or counties with the characteristic, and the 1 represents the denominator, or the counties without the characteristic.
“A” Counties where Adult Age 60+ is 23%+ of County population
Side-by-side bar charts illustrate how Counties are faring in the covid-19 crises when grouped by size of population and median income and split by those above and below the characteristic’s average.
Update on Past Analyses
Above Average Minority Counties. US counties where populations of African American or Hispanic are 50% or above the US averages — that is, 19%+ for African American or 27%+ for Hispanic — have 43% of the US population and account for 52% of US covid-19 deaths. We note that D Counties with above average Minority populations also have very large covid-19 death rates (bottom orange bar at right), though this is a small number overall. Note this chart will be replaced with the current analysis charts next week.
Counties with 19%+ African American or 27%+ Hispanic (orange) or not (blue) by County Size
Age 60+. 35% of the US population live in older Counties defined as above average Age 60+ populations (orange bars on the left graph). Since 8 of 10 covid-19 deaths are adults 65 years and older Counties with above average Age 60+ populations, especially C and D Counties, are vulnerable in the covid crisis.
Counties where Adult Age 60+ is (orange) or is not (blue) 23%+ of County population by County Size
Heart Disease. It may seem like Heart Disease is a “city problem”, and it is, even when New York state is removed most covid-19 deaths are found in counties with above average Heart Disease deaths. Populations in rural C and D Counties with above average Heart Disease deaths also have relatively more covid-19 deaths. These Counties also have older age populations.
Counties where Heart Disease causes 0.2% or more population deaths (orange) or not (blue)
Cancer. The above average Cancer death Counties (orange bars in the charts) account for 38% of the US population and 27% of covid-19 deaths. The chart shows that above average Cancer deaths trends with covid-19 deaths. When New York state is removed, however, the share of covid-19 deaths exceed the population percentage of above average Cancer death Counties among the 38 remaining “A” counties. These Counties also have older age populations.
Counties where Cancer causes 0.19% or more population deaths (orange) or not (blue) by County Size
More on County Groups, more on the US Excluding NY
3,142 US Counties are geographic and administrative districts for which lots of statistics are gathered, including covid-19 deaths. Each County can be characterized as urban and rural, and they range in population from 10.2 million (LA County, CA) down to 88 (Kalawao County, HI) residents. In these reports, comparisons are made between four groups of counties depending on population size and by median income bands, as indicated in the chart axes.
New York state accounts for 6% of the US population and disproportionately more covid-19 deaths, so it is useful to consider total US results excluding New York state. This is done in the chart below which shows a disproportionate majority of covid-19 deaths occurring suburban B Counties across the US but excluding New York State (second bar on right graph).
US Population and Covid-19 Deaths by County Size Group — Excluding NY State
In future reports we’ll continue to examine county health statistics that might help put covid-19 statistics in helpful light.
Some other measures that may tell the developing covid-19 story:
- How do Covid-19 deaths change when adjusted for the first date one was reported?
- Do Counties’ previous flu or respiratory deaths tell us about County covid-19 death rates?
- Do County median income or education tell us about the likelihood of covid-19 deaths?
- Do results change if we use the exact density of County population instead of County Size?
- Do average temperatures or levels of particulate matters matter?
If you have any questions about this analysis or the data, or if you have suggestions, please don’t hesitate to contact me.
Sources: US Census, USA Facts Covid-19, IHME forecasts, US Cancer Deaths NIH 5 year average, CDC Handbook on Death Reporting, 2003; New York Times; Median Income; CDC Wonder Detailed Mortality; CDC Fine Particulate Matter 2003–2011