Unequal burdens: assessing the determinants of elevated COVID-19 case and death rates in New York City’s racial/ethnic minority neighbourhoods

Background The disproportionate burden of the COVID-19 pandemic on racial/ethnic minority communities has revealed glaring inequities. However, multivariate empirical studies investigating its determinants are still limited. We document variation in COVID-19 case and death rates across different racial/ethnic neighbourhoods in New York City (NYC), the initial epicentre of the U.S. coronavirus outbreak, and conduct a multivariate ecological analysis investigating how various neighbourhood characteristics might explain any observed disparities. Methods Using ZIP-code-level COVID-19 case and death data from the NYC Department of Health, demographic and socioeconomic data from the American Community Survey and health data from the Centers for Disease Control’s 500 Cities Project, we estimated a series of negative binomial regression models to assess the relationship between neighbourhood racial/ethnic composition (majority non-Hispanic White, majority Black, majority Hispanic and Other-type), neighbourhood poverty, affluence, proportion of essential workers, proportion with pre-existing health conditions and neighbourhood COVID-19 case and death rates. Results COVID-19 case and death rates for majority Black, Hispanic and Other-type minority communities are between 24% and 110% higher than those in majority White communities. Elevated case rates are completely accounted for by the larger presence of essential workers in minority communities but excess deaths in Black neighbourhoods remain unexplained in the final model. Conclusions The unequal COVID-19 case burden borne by NYC’s minority communities is closely tied to their representation among the ranks of essential workers. Higher levels of pre-existing health conditions are not a sufficient explanation for the elevated mortality burden observed in Black communities