[Skip to Content]

Claim CME

Public Health

Associations of Race/Ethnicity and Food Insecurity With COVID-19 Infection Rates Across US Counties

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: June 8, 2021

Original Investigation

Article Information and Disclosures

Mumbi E. Kimani, PhD¹;

Mare Sarr, PhD^2,3;

Yendelela Cuffee, PhD⁴;

Chang Liu, MS⁵;

Nicole S. Webster, PhD⁶

Author Affiliations

¹School of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa
²School of International Affairs, Pennsylvania State University, University Park
³School of Economics, University of Cape Town, Rondebosch, South Africa
⁴College of Health Sciences, University of Delaware, Newark
⁵College of Education, Pennsylvania State University, University Park
⁶College of Agricultural Sciences, Pennsylvania State University, University Park

Read article on JAMA Network

Read Article Claim CME

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.

Abstract

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.

Claim CME

Sign in to take quiz and track your certificates

Buy This Activity

Article Information

Accepted for Publication: April 12, 2021.

Published: June 8, 2021. doi:10.1001/jamanetworkopen.2021.12852

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Kimani ME et al. JAMA Network Open.

Corresponding Author: Mare Sarr, PhD, School of International Affairs, Pennsylvania State University, 235 Lewis Katz Bldg, University Park, PA 16802 (mxs2566@psu.edu).

Author Contributions: Drs Kimani and Sarr had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kimani, Sarr, Cuffee, Webster.

Acquisition, analysis, or interpretation of data: Kimani, Sarr, Liu.

Drafting of the manuscript: Kimani, Sarr, Cuffee, Webster.

Critical revision of the manuscript for important intellectual content: Kimani, Sarr, Liu.

Statistical analysis: Kimani, Sarr, Liu.

Obtained funding: Webster.

Administrative, technical, or material support: Liu, Webster.

Supervision: Kimani, Sarr, Webster.

Editing: Webster.

Conflict of Interest Disclosures: None reported.

Funding/Support: Dr Webster was supported by the Impacts of COVID-19 on Agricultural, Food, and Environmental Systems Grant from the Pennsylvania State University College of Agricultural Sciences.

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.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.