This cross-sectional study investigates the associations of race/ethnicity and food insecurity with COVID-19 infection rates in US counties. Key Points Question Are racial/ethnic population composition and food insecurity associated with COVID-19 infection rates? Findings This cross-sectional study of 3133 US counties found that there was an association between race/ethnicity and COVID-19 infection rate, with an interaction with food insecurity in counties with large Black and American Indian or Alaska Native populations but not in counties with large Hispanic populations. Meaning These findings suggest that public policy aimed at fighting COVID-19 should consider county-level food insecurity to better understand the social dynamics of the disease. Importance Food insecurity is prevalent among racial/ethnic minority populations in the US. To date, few studies have examined the association between pre–COVID-19 experiences of food insecurity and COVID-19 infection rates through a race/ethnicity lens. Objective To examine the associations of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates and the interactions of race/ethnicity and food insecurity, while controlling for demographic, socioeconomic, risk exposure, and geographic confounders. Design, Setting, and Participants This cross-sectional study examined the associations of race/ethnicity and food insecurity with cumulative COVID-19 infection rates in 3133 US counties, as of July 21 and December 14, 2020. Data were analyzed from November 2020 through March 2021. Exposures Racial/ethnic minority groups who experienced food insecurity. Main Outcomes and Measures The dependent variable was COVID-19 infections per 1000 residents. The independent variables of interest were race/ethnicity, food insecurity, and their interactions. Results Among 3133 US counties, the mean (SD) racial/ethnic composition was 9.0% (14.3%) Black residents, 9.6% (13.8%) Hispanic residents, 2.3% (7.3%) American Indian or Alaska Native residents, 1.7% (3.2%) Asian American or Pacific Islander residents, and 76.1% (20.1%) White residents. The mean (SD) proportion of women was 49.9% (2.3%), and the mean (SD) proportion of individuals aged 65 years or older was 19.3% (4.7%). In these counties, large Black and Hispanic populations were associated with increased COVID-19 infection rates in July 2020. An increase of 1 SD in the percentage of Black and Hispanic residents in a county was associated with an increase in infection rates per 1000 residents of 2.99 (95% CI, 2.04 to 3.94; P < .001) and 2.91 (95% CI, 0.39 to 5.43; P = .02), respectively. By December, a large Black population was no longer associated with increased COVID-19 infection rates. However, a 1-SD increase in the percentage of Black residents in counties with high prevalence of food insecurity was associated with an increase in infections per 1000 residents of 0.90 (95% CI, 0.33 to 1.47; P = .003). Similarly, a 1-SD increase in the percentage of American Indian or Alaska Native residents in counties with high levels of food insecurity was associated with an increase in COVID-19 infections per 1000 residents of 0.57 (95% CI, 0.06 to 1.08; P = .03). By contrast, a 1-SD increase in Hispanic populations in a county remained independently associated with a 5.64 (95% CI, 3.54 to 7.75; P < .001) increase in infection rates per 1000 residents in December 2020 vs 2.91 in July 2020. Furthermore, while a 1-SD increase in the proportion of Asian American or Pacific Islander residents was associated with a decrease in infection rates per 1000 residents of −1.39 (95% CI, −2.29 to 0.49; P = .003), the interaction with food insecurity revealed a similar association (interaction coefficient, −1.48; 95% CI, −2.26 to −0.70; P < .001). Conclusions and Relevance This study sheds light on the association of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates in the United States. These findings suggest that the channels through which various racial/ethnic minority population concentrations were associated with COVID-19 infection rates were markedly different during the pandemic.
【초록키워드】 COVID-19, pandemic, cross-sectional, food insecurity, Infection, risk, Population, Prevalence, COVID-19 infection, infection rate, women, group, interactions, association, Hispanic, food, Interaction, Concentration, exposure, Asian, black, Older, independent variable, 95% CI, individual, measure, confounders, white, participant, finding, cumulative, Alaska, The United States, objective, populations, setting, decrease, prevalent, Result, analyzed, examined, proportion, remained, the disease, increase in, Importance, the mean, Native, Point, Relevance, with COVID-19, 【제목키워드】 COVID-19, food, insecurity, Rate,