FORTHCOMING IN Journal of Racial and Ethnic Health Disparities Racial disparities in COVID-19 impacts in Michigan, USA Kaston D. Anderson-Carpenter · Zachary P. Neal Abstract Racial disparities have been observed in the Introduction impacts of COVID-19 in the United States. In this pa- per, we used a representative sample of adults in Michi- Since the first confirmed case of the novel coronavirus gan to examine differences in COVID-19 impacts on (COVID-19) was reported in the United States on Jan- Blacks and Whites in four domains: direct, perceived, uary 22, 2020, there has been an dramatic increase in political, and behavioral. We found that in the ini- morbidity and mortality rates due to the virus. Multi- tial wave of the outbreak in May 2020, Blacks expe- ple studies of emerging national and local data suggests rienced more severe direct impacts: they were more that communities of color are disparately affected by likely to be diagnosed or know someone who was di- COVID-19, thus exacerbating existing health dispari- agnosed, and more likely to lose their job compared to ties [e.g.,1, 24, 19, 29,2, 28]. In the state of Michigan, Whites. Additionally, Blacks differed significantly from for example, Blacks comprise approximately 14.1% of Whites in their assessment of COVID-19's threat to the population yet make up more than 35% of deaths public health and the economy, the adequacy of govern- as of 5 November 2020 [22]. ment responses to COVID-19, and the appropriateness Although influencing factors of disproportionate of behavioral changes to mitigate COVID-19's spread. rates among Blacks remain largely unknown, the exist- Although in many cases these views of COVID-19 were ing literature cites several potential contributors. It is also associated with political ideology, this association now known that individuals with compromised immune was significantly stronger for Whites than Blacks. Con- systems or pre-existing health conditions are more sus- tinued investigation of racial disparities in COVID-19's ceptible to acquiring COVID-19, and Blacks experience impact is necessary, however these preliminary findings greater prevalence of certain health conditions such as of a race-by-ideology interaction are important because Type 2 diabetes, hypertension, and asthma. Addition- they suggest some racial disparities are restricted to ally, social determinants of health have been shown conservatives, while more liberal Whites and Blacks ex- to play a major role in health outcomes. For exam- hibit few differences. ple, socioeconomic status, education, and access to care have been cited as explanatory factors in both physical Keywords COVID-19 · SARS-CoV-2 · political and mental health in various populations. In Michigan, ideology · racial disparities · public health such determinants contribute to greater disparities in Kaston D. Anderson-Carpenter health outcomes for Black residents. As more data be- Psychology Department come available, estimates of and explanations for dif- Michigan State University ferences in COVID-19 prevalence and impacts will im- 316 Physics Rd. prove. However, to date few studies of COVID-related East Lansing, MI 48824 Tel.: +1517-432-0686 racial disparities have considered the potential intersec- E-mail: [email protected] tional role of political ideology. Zachary P. Neal In response to the recent call to action [18], and Psychology Department seeking to explore the ways that race and politics may Michigan State University intersect to generate racial disparities, in this paper 2 Kaston D. Anderson-Carpenter, Zachary P. Neal we examine the associations of race, political ideol- demonstrate the disproportionately negative impact of ogy, and their interaction with several direct and in- COVID-19 on Blacks in the United States. For instance, direct COVID outcomes during the peak of the pan- hospitalization data from New York City suggest that demic's first wave in Michigan. As expected based on Blacks are twice as likely to require COVID-related hos- prior studies, we find evidence of racial disparities in pitalizations compared to their White peers [29], and these outcomes between Black and White respondents. Blacks were disproportionately represented in COVID- In addition, we observe that although several outcomes related mortality cases compared to Whites. Other are also associated with political ideology, this associa- work suggests that communities with greater concen- tion tends to be significantly stronger for Whites than trations of Blacks showed substantially more cases of Blacks. That is, we observe that although COVID and COVID-19 [1,2, 19] These findings may be partially its impacts have become heavily politicized, there are explained by the fact that Blacks are more likely to racial disparities in the extent of its politicization. present with comorbidities such as hypertension and The remainder of the paper is organized in four sec- Type 2 diabetes than their White counterparts, and are tions. In the background section we briefly review past also disproportionately affected by stress and other so- research on racial disparities in COVID-19 and similar cial determinants of health such as unemployment and pandemic events. In the methods section, we describe lack of adequate access to healthcare [28]. the State of the State Survey of Michigan adults con- Differences in the perceived impacts of COVID-19 ducted in May 2020, which we use to measure a range have yet to be fully explored in the United States. That of COVID outcomes including diagnosis, perceptions said, news reports point to a potential difference in per- of severity, and adherence to behavioral changes. In the ceived susceptibility (i.e., subjective perception of the results section, we first report population estimates of risk of acquiring COVID-19) and severity of the virus these outcomes, then report our findings from a series (i.e., feelings on, and perceptions of, the seriousness of of logistic and linear regressions estimating the associ- acquiring COVID-19) on overall health. More specifi- ation of race, political ideology, and their interaction cally, there is some evidence of differential feelings of on these COVID outcomes. In the discussion section, the seriousness of acquiring COVID-19. Media outlets we conclude by discussing the implications of an ongo- have reported on \coronavirus parties" in the United ing and highly politicized public health crisis that has States; In one state, it was reported that students at- racially disparate impacts in multiple domains. tended such a party in an effort to acquire and/or trans- mit COVID-19 [15]. Additionally, some individuals in the US resist behavioral preventive measures such as Background staying at home and wearing face masks as an affront Racial disparities in health outcomes have been long to freedom of expression; others who acquire the virus documented in the United States [5,6,9, 13, 30, 34]. may refuse participation in contact tracing. These ac- With the growing implications of COVID-19 on Amer- tivities may be a byproduct of rising levels of health ican public health, the existing disparities may be fur- and economic anxiety. In a recent nationwide commu- ther heightened. The emerging findings suggests that nity sample, scholars have found that being under a Blacks are at a greater risk of acquiring and dying from stay-at-home order and perceived negative impacts of COVID-19 compared to their White peers, which may COVID-19 on daily life were independently associated be exacerbated by prevailing disparities in economic with greater health anxiety and economic worry [31]. stability and healthcare access [23,4]. Some of the resistance in practicing preventive mea- Since the first case of COVID-19 appeared in Wash- sures may be influenced by ideological orientation. Em- ington State in February 2020, unemployment in the pirical evidence suggests that conservatism is correlated United States increased 217% by June 2020. During with engagement in more conspiracy-related informa- this period, Black Americans consistently experienced tion and media exaggeration. For example, recent work a greater unemployment rate, with June 2020 estimates has shown that individuals who identified as Repub- of 15.4% unemployment compared to 10.1% unemploy- licans and conservatives perceived a lower COVID-19 ment for their White peers [32]. These recent findings related vulnerability compared to Democrats and lib- are consistent with studies demonstrating that Blacks erals [8]. These results mirror prior work that suggests experience lower levels of economic stability and higher political ideology is associated with a fear of threat and rates of unemployment compared to their White coun- loss [16]. terparts [12, 17, 27], The fact that conservatism was associated with Recent empirical studies published in the Jour- lower threat perception of COVID-19 may be due, in nal of Racial and Ethnic Health Disparities further part, to the impact of prevailing political leadership Racial disparities in COVID impacts 3 and partisan media [8]. On the one hand, liberal-leaning ence significantly different direct, perceived, ideological, media outlets have attributed the current downplay of and behavioral effects of COVID-19 compared to their COVID-19 related vulnerability to the current presi- ideologically conservative counterparts, and (3) politi- dential administration and the Republican party [11]. cal ideology will significantly moderate the relationship On the other hand, conservative-leaning outlets have between race and COVID-19