Racial Disparities in COVID-19 Case Positivity and Social Context: The Role of Housing, Neighborhood, and Health Insurance

Abstract

Research on racial-ethnic COVID-19 disparities has yet to employ housing variables measured at the individual level, limiting our understanding of housing’s role in determining early exposure to the virus. To address this gap, we linked data from SARS-CoV-2 polymerase chain reaction (PCR) tests within the Duke University Health System between March 12, 2020, and July 31, 2020 (N = 23,057 individuals), with housing parcel data. We then analyzed how housing, neighborhood, and health insurance explain disparities in case positivity between and within racial-ethnic groups in Durham County, North Carolina. We find that 55% of the Black–White disparity and 25% of the Hispanic–White disparity in positive cases are explained by these social-contextual variables. Neighborhood-fixed effects explained the largest portion (27%) of the Black–White disparity, whereas health insurance type explained the largest portion (14%) of the Hispanic–White disparity. We conclude that housing, neighborhood, and health insurance had a significant role in producing racial-ethnic disparities in COVID-19 case positivity.

Keywords:

• COVID-19
• housing
• neighborhood characteristics
• health insurance
• racial disparities

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Funding for this project came from the Duke University Offices of the Vice Provost for Interdisciplinary Studies and Durham & Community Affairs, and the Duke Sanford School of Public Policy.

Notes on contributors

Warren Lowell

Warren Lowell, MPP is a PhD student in Duke University’s joint degree program in sociology and public policy. He is training to become a mixed methodologist with substantive focuses on housing policy, gentrification, homelessness, and racism.

Sarah Dickerson

Sarah Dickerson, PhD is a postdoctoral researcher and adjunct professor at Duke’s Sanford School of Public Policy. Her research interests include maternal and child well-being, with a focus on marginalized and impoverished populations.

Anna Gassman-Pines

Anna Gassman-Pines, PhD is an associate professor with the Sanford School of Public Policy at Duke University. Her areas of expertise are child development in low-income families, social policy, and workplace contexts.

Elizabeth Gifford

Elizabeth Gifford, PhD is an associate research professor at the Sanford School of Public Policy at Duke University. She is leading the Social and Economic Component of the Children’s Health and Discovery Institute housed within the Duke School of Medicine Department of Pediatrics.

Marcos Rangel

Marcos Rangel, PhD is an economist with the Sanford School of Public Policy at Duke University and a research scholar at the Duke Population Research Institute (DUPRI). His research focuses on racial disparities among children and the impact of policies to foment education and health.