Racial Disparities in the Epidemiology of COVID-19 in Georgia: Trends since State-Wide Reopening

Objective: To examine county-level factors associated with coronavirus disease 2019 (COVID-19) incidence and mortality in Georgia, focusing on changes after relaxation of "shelter-in-place"orders on April 24, 2020. Methods: County-level data on confirmed COVID-19 cases and deaths were obtained from the Johns Hopkins 2019 Novel Coronavirus Data Repository and linked with county-level data from the 2020 County Health Rankings. We examined associations of county-level factors with mortality and incidence rates (quantiles) using a logistic regression model. This research was conducted in June-July 2020 in Augusta, GA. Results: Counties in the highest quartile for mortality had higher proportions of non-Hispanic (NH)-Black residents (median: 37.4%; interquartile range [IQR]: 29.5-45.0; p<0.01) and residents with incomes less than $20,000 (median: 32.9%; IQR: 26.6-35.0; p<0.01). Counties in the highest quartile for NH-Black residents (38.7-78.0% NH-Black population) showed a 13-fold increase in odds (odds ratio=13.15, 95% confidence interval=1.40-123.80, p=0.05) for increased COVID-19 mortality controlling for income. Conclusions: Although highlighted by the pandemic, racial disparities predated COVID-19, exposing the urgency for diversion of resources to address the systematic residential segregation, educational gaps, and poverty levels experienced disproportionately by Black communities.