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Disparities in Coronavirus 2019 Reported Incidence, Knowledge, and Behavior Among US Adults

Educational Objective
To understand how the reporting of, the knowledge of, and the behavior about COVID-19 varies across the United States
1 Credit CME
Key Points

Question  How do reported incidence, knowledge, and behaviors regarding coronavirus disease 2019 vary across sociodemographic characteristics in the US?

Findings  In this survey study, the largest differences in coronavirus disease 2019–related knowledge and behaviors were associated with race/ethnicity, sex, and age. African American participants, men, and people younger than 55 years were less likely to know how the disease is spread, were less likely to know the symptoms of coronavirus disease 2019, and left the home more often.

Meaning  These findings suggest that more effort is needed to increase accurate information and encourage appropriate behaviors among minority communities, men, and younger people.

Abstract

Importance  Data from the coronavirus disease 2019 (COVID-19) pandemic in the US show large differences in hospitalizations and mortality across race and geography. However, there are limited data on health information, beliefs, and behaviors that might indicate different exposure to risk.

Objective  To determine the association of sociodemographic characteristics with reported incidence, knowledge, and behavior regarding COVID-19 among US adults.

Design, Setting, and Participants  A US national survey study was conducted from March 29 to April 13, 2020, to measure differences in knowledge, beliefs, and behavior about COVID-19. The survey oversampled COVID-19 hotspot areas. The survey was conducted electronically. The criteria for inclusion were age 18 years or older and residence in the US. Data analysis was performed in April 2020.

Main Outcomes and Measures  The main outcomes were incidence, knowledge, and behaviors related to COVID-19 as measured by survey response.

Results  The survey included 5198 individuals (mean [SD] age, 48 [18] years; 2336 men [45%]; 3759 white [72%], 830 [16%] African American, and 609 [12%] Hispanic). The largest differences in COVID-19–related knowledge and behaviors were associated with race/ethnicity, sex, and age, with African American participants, men, and people younger than 55 years showing less knowledge than other groups. African American respondents were 3.5 percentage points (95% CI, 1.5 to 5.5 percentage points; P = .001) more likely than white respondents to report being infected with COVID-19, as were men compared with women (3.2 percentage points; 95% CI, 2.0 to 4.4 percentage points; P < .001). Knowing someone who tested positive for COVID-19 was more common among African American respondents (7.2 percentage points; 95% CI, 3.4 to 10.9 percentage points; P < .001), people younger than 30 years (11.6 percentage points; 95% CI, 7.5 to 15.7 percentage points; P < .001), and people with higher incomes (coefficient on earning ≥$100 000, 12.3 percentage points; 95% CI, 8.7 to 15.8 percentage points; P < .001). Knowledge of potential fomite spread was lower among African American respondents (−9.4 percentage points; 95% CI, −13.1 to −5.7 percentage points; P < .001), Hispanic respondents (−4.8 percentage points; 95% CI, −8.9 to −0.77 percentage points; P = .02), and people younger than 30 years (−10.3 percentage points; 95% CI, −14.1 to −6.5 percentage points; P < .001). Similar gaps were found with respect to knowledge of COVID-19 symptoms and preventive behaviors.

Conclusions and Relevance  In this survey study of US adults, there were gaps in reported incidence of COVID-19 and knowledge regarding its spread and symptoms and social distancing behavior. More effort is needed to increase accurate information and encourage appropriate behaviors among minority communities, men, and younger people.

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Article Information

Accepted for Publication: May 22, 2020.

Published: June 18, 2020. doi:10.1001/jamanetworkopen.2020.12403

Correction: This article was corrected on June 26, 2020, to fix the second sentence of the Findings in the Key Points.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Alsan M et al. JAMA Network Open.

Corresponding Author: David Cutler, PhD, Department of Economics, Harvard University, 1805 Cambridge St, Littauer Center 226, Cambridge, MA 02138 (dcutler@harvard.edu).

Author Contributions: Dr Alsan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Stantcheva, Yang, Cutler.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Stantcheva, Yang, Cutler.

Statistical analysis: All authors.

Obtained funding: Stantcheva, Yang.

Administrative, technical, or material support: Stantcheva, Yang, Cutler.

Supervision: Alsan, Stantcheva.

Conflict of Interest Disclosures: Dr Cutler reported receiving nonfinancial support from the Health Policy Commission of Massachusetts; personal fees and nonfinancial support from American Medical Association, Brookings Institution, Mercer, and Colorado Center for Nursing Excellence; and personal fees from the Fidelity Scientific Advisory Board and MDL Litigation outside the submitted work. Dr Cutler also reported serving on the Academic and Policy Advisory Board of Kyruus, Inc and the Advisory Board of Firefly Health and holding nonpaid positions at the National Academy of Medicine, National Bureau of Economic Research, National Academy of Social Insurance, and Center for American Progress. No other disclosures were reported.

Funding/Support: The Harvard Kennedy School provided financial support for this work.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Sarah Eichmeyer, BA (Stanford University), Luca Bragheri, BA (Stanford University), and Dynata Corporation provided assistance in data collection. Joyce Kim, BA (Harvard Kennedy School), and Archie Hall, BA (Harvard University), provided assistance in data analysis. They were not compensated for these contributions beyond their salaries.

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