We provide an empirical summary of the relationship between socioeconomic status and the economic and disease burden of the SARS-CoV2 pandemic in the United States. We rely on large-scale public data, including a zip code database we constructed from public records, to investigate the relationship between socioeconomic status and the risk of economic harm, COVID-19 infection, or COVID-19-related death. We find that low levels of education and income are associated with 1.3 to 2 times higher risk of economic harm and 2 to 3 times greater physical harm. Education and income have a similar effect size to racial and ethnic disparities, with many Americans of color facing worse outcomes. Using Gallup data to investigate potential mechanisms, we find that socioeconomic status is not related to preventative behavior like mask use but is related to occupation-related exposure, which puts lower-socioeconomic-status households at risk.
AnandShuchiMontez-RathMariaHanJialinBozemanJulieKerschmannRussellBeyerPaulParsonnetJulieChertowGlenn M. 2020. Prevalence of SARS-CoV-2 antibodies in a large nationwide sample of patients on dialysis in the USA: A cross-sectional study. The Lancet396 (10259): 1335–44. Available from https://doi.org/10.1016/S0140-6736(20)32009-2.
2.
BaileyZinzi D.KriegerNancyAgénorMadinaGravesJasmineLinosNataliaBassettMary T.. 2017. Structural racism and health inequities in the USA: Evidence and interventions. The Lancet389 (10077): 1453–63.
3.
BrunelloGiorgioFortMargheritaSchneeweisNicoleWinter-EbmerRudolf. 2016. The causal effect of education on health: What is the role of health behaviors?Health Economics25 (3): 314–36.
4.
Centers for Disease Control and Prevention. 2021a. About social determinants of health (SDOH). Washington, DC: Centers for Disease Control and Prevention. Available from https://www.cdc.gov/socialdeterminants/about.html.
5.
Centers for Disease Control and Prevention. 2021b. COVID-19 hospitalization and death by race/ethnicity. Washington, DC: Centers for Disease Control and Prevention. Available from https://www.cdc.gov.
ChettyRajFriedmanJohn N., Nathaniel Hendren, Michael Stepner, and The Opportunity Insights Team. 2020. The economic impacts of COVID-19: Evidence from a new public database built using private sector data. NBER Working Paper No. 27431, National Bureau of Economic Research, Cambridge, MA.
9.
ChettyRajHendrenNathanielJonesMaggie R.PorterSonya R.. 2020. Race and economic opportunity in the United States: An intergenerational perspective. Quarterly Journal of Economics135 (2): 711–83.
10.
CurrieJanet. 2009. Healthy, wealthy, and wise: Socioeconomic status, poor health in childhood, and human capital development. Journal of Economic Literature47 (1): 87–122.
11.
DaviesNeil M.DicksonMattSmithGeorge DaveyVan Den BergGerard J.WindmeijerFrank. 2018. The causal effects of education on health outcomes in the UK Biobank. Nature Human Behaviour2 (2): 117–25.
12.
DobsonEmilyGrahamCarolDoddEthan. 2021. When public health crises become entwined: How trends in COVID-19, deaths of despair, and well-being track across the U.S.A. The ANNALS of the American Academy of Political and Social Science (this volume).
13.
ElliottDebbie. 16February2021. In Tuskegee, painful history shadows efforts to vaccinate African Americans. NPR. Available from https://www.npr.org.
14.
FeinsteinJonathan S.1993. The relationship between socioeconomic status and health: A review of the literature. Milbank Quarterly71 (2): 279–322.
15.
FunkCaryTysonAlec. 3December2020. Intent to get a COVID-19 vaccine rises to 60% as confidence in research and development process increases. Washington, DC: Pew Research Center. Available from https://www.pewresearch.org.
16.
FurnéeCarina A.GrootWimMaassen van Den BrinkHenriëtte. 2008. The health effects of education: A meta-analysis. European Journal of Public Health18 (4): 417–21.
17.
GrahamCarolHamiltonBarton H.ChunYungRollStephenRossWillJoynt MaddoxKaren E.Grinstein-WeissMichal. 2021. Coping with Covid-19: Implications of differences in resilience across racial groups for mental health and well-being. The ANNALS of the American Academy of Political and Social Science (this volume).
18.
GramlichJohnFunkCary. 4June2020. Black Americans face higher COVID-19 risks, are more hesitant to trust medical scientists, get vaccinated. Washington, DC: Pew Research Center. Available from https://www.pewresearch.org.
19.
HawkinsR. B.CharlesE. J.MehaffeyJ. H.. 2020. Socio-economic status and COVID-19–related cases and fatalities. Public Health189:129–34. Available from https://doi.org/10.1016/j.puhe.2020.09.016.
20.
JayJonathanBorJacobNsoesieElaine O.LipsonSarah K.JonesDavid K.GaleaSandroRaifmanJulia. 2020. Neighbourhood income and physical distancing during the COVID-19 pandemic in the United States. Nature Human Behaviour4 (12): 1294–1302. Available from https://doi.org/10.1038/s41562-020-00998-2.
21.
KimSoo RinVanMatthewBronnerLauraMantheyGrace. 22July2020. Which cities have the biggest racial gaps in COVID-19 testing access? FiveThirtyEight. Available from https://fivethirtyeight.com.
22.
KnittelChristopher R.OzaltunBora. 22June2020. What does and does not correlate with COVID-19 death rates?NBER Working Paper No. 27391, National Bureau of Economic Research, Cambridge, MA. Available from https://doi.org/10.3386/w27391.
23.
KomaWyattArtigaSamanthaNeumanTriciaClaxtonGaryRaeMatthewKatesJenniferMichaudJosh. 7May2020. Low-income and communities of color at higher risk of serious illness if infected with Coronavirus. Kaiser Family Foundation. Available from https://www.kff.org/coronavirus-covid-19.
24.
LucykKelseySimmondsKimberley A.LorenzettiDiane L.DrewsSteven J.SvensonLawrence W.RussellMargaret L.. 2019. The association between influenza vaccination and socioeconomic status in high income countries varies by the measure used: A systematic review. BMC Medical Research Methodology19 (1): 1–23.
25.
MakridisChristosRothwellJonathan T.. 29June2020. The real cost of political polarization: Evidence from the COVID-19 pandemic. Available from http://dx.doi.org/10.2139/ssrn.3638373.
26.
MamelundSvenn-ErikShelley-EganClareRogebergOle. 2019. The association between socioeconomic status and pandemic influenza: Protocol for a systematic review and meta-analysis. Systematic Reviews8 (1): 1–6.
MongeySimonPilossophLauraWeinbergAlex. 4May2020. Which workers bear the burden of social distancing policies?NBER Working Paper No. 27085, National Bureau of Economic Research, Cambridge, MA. Available from https://doi.org/10.3386/w27085.
29.
MutambudziMiriamNiedwiedzClaireMacdonaldEwan BeatonLeylandAlastairMairFrancesAndersonJanaCelis-MoralesCarlos, et al. 2020. Occupation and risk of severe COVID-19: Prospective cohort study of 120 075 UK Biobank participants. Occupational and Environmental Medicine78 (5): 307–14.
30.
OgedegbeGbengaRavenellJosephAdhikariSamrachanaButlerMarkCookTiffanyFrancoisFritzIturrateEduardo, et al. 2020. Assessment of racial/ethnic disparities in hospitalization and mortality in patients with COVID-19 in New York City. JAMA Network Open3 (12): e2026881.
31.
PapageorgeNicholas W.ZahnMatthew V.BelotMichèlevan den Broek-AltenburgElineChoiSyngjooJamisonJulian C.TripodiEgon. 15June2020. Socio-demographic factors associated with self-protecting behavior during the Covid-19 pandemic. NBER Working Paper No. 27378, National Bureau of Economic Research, Cambridge, MA. Available from https://doi.org/10.3386/w27378.
32.
ParkerKimMinkinRachelBennettJesse. 30October2020. Economic fallout from COVID-19 continues to hit lower-income Americans the hardest. Washington, DC: Pew Research Center’s Social & Demographic Trends Project. Available from https://www.pewsocialtrends.org/.
33.
RaifmanMatthew A.RaifmanJulia R.. 2020. Disparities in the population at risk of severe illness from COVID-19 by race/ethnicity and income. American Journal of Preventive Medicine59 (1): 137–39. Available from https://doi.org/10.1016/j.amepre.2020.04.003.
34.
RothwellJonathan. 2019. A republic of equals: A manifesto for a just society. Princeton, NJ: Princeton University Press.
RugglesStevenFloodSarahFosterSophiaGoekenRonaldPacasJoseSchouweilerMeganSobekMatthew. 2021. IPUMS USA: Version 11.0 [2019 American Community Survey]. Minneapolis, MN. Available from https://doi.org/10.18128/D010.V11.0.
U.S. Bureau of Labor Statistics. 8January2021. E-16. Unemployment rates by age, sex, race, and Hispanic or Latino ethnicity. Washington, DC: U.S. Bureau of Labor Statistics. Available from https://www.bls.gov/web/empsit/cpsee_e16.htm.
WanbergConnie R.CsillagBorbalaDouglassRichard P.ZhouLePollardMichael S.. 2020. Socioeconomic status and well-being during COVID-19: A resource-based examination. Available from https://psycnet.apa.org/fulltext/2020-77456-001.html.
ZhangY.WuS. S.YangP.LiC.ChuY. H.HuaW. Y.ZhangH. Y.TangY. Q.LiH. J.WangQ. Y.. 2016. Association between socio-economic status indicators and adoption of preventive measures for influenza among Beijing residents: A cross-sectional study. Public Health140:282–85.
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