ST. LOUIS, May 7, 2020 — New research on the influence of COVID-19 among St. Louis-area communities finds the region’s African American and Black residents have been especially hard hit by the crisis. The research suggests that COVID-19 mitigation strategies should include a race-conscious lens that can inform policy and public health solutions to the crisis.
“While age and the presence of chronic conditions — such as diabetes and heart disease — are significant predictors of morbidity and mortality among individuals contracting the COVID-19 virus, these factors alone do not explain the disproportionate impact of COVID-19 on Black communities in St. Louis and around the country,” said Angela Brown, coauthor and CEO of the St. Louis Regional Health Commission. “The growing body of evidence indicates that social determinants of health, which track with but are not perfectly aligned with race, is a strong indicator of risk.”
Researchers analyzed confirmed COVID-19 cases and racial composition for 113 ZIP codes throughout the St. Louis region, including the City of St. Louis, St. Louis County, St. Charles County, Jefferson County and Franklin County. Using local public health case data from April 13 and April 20, researchers identified the COVID-19 rates throughout the survey area, finding a range of 0 cases in 17 ZIP codes to 677 per 100,000 in the highest ZIP code — 63113, The Ville neighborhood in North St. Louis City.
To further explore the issue, researchers analyzed St. Louis regional ZIP codes by the percentage of the total population being Black or African American, and were evaluated by the number and incidence of confirmed COVID-19 cases on April 20 — a one-week change in the number of confirmed cases from April 13 — and the proportion of regional cases compared to the proportion of regional population. Throughout the region’s 113 ZIP codes, the percent of the population identifying as Black or African American ranges from 0% to 98.4% while population density ranges from 10.6 to 9,267 residents per square mile.
Confirmed COVID-19 cases, as a rate of the population, largely were clustered in communities in North St. Louis City and County on April 20. Researchers organizing ZIP codes by proportion of the Black or African American population in each ZIP code at less than 5%, between 5% and 50%, and over 50%. This analysis revealed that the 19 ZIP codes with a majority Black or African American population had a combined rate of COVID-19 cases near 400 per 100,000 residents, while the 68 ZIP codes with fewer than 5% Black or African American residents had 127 cases per 100,000 residents on April 20.
“Understanding the connection between race and geography can allow stakeholders to better allocate resources to these at-risk communities,” said Mat Reidhead, lead author and Vice President of Research and Analytics at the Missouri Hospital Association. “Testing and outcomes tracking among Black and African American individuals and communities can help reduce spread and harm within these communities. National research suggests race disparities exist not only in Black and African American community-level case rates, but through stark disparities in hospitalization and fatality rates.”
Resources are being directed to mitigate disparities in the St. Louis region. PrepareSTL, a region-wide communication campaign funded by the Missouri Foundation for Health in partnership with the Regional Health Commission, the City of St. Louis, St. Louis County and other community health organizations, was established mid-March. The campaign deploys community health workers and other community volunteers to provide culturally appropriate messages on how to mitigate COVID-19 while remaining physically, emotionally and economically secure.
Additional testing is occurring in the predominately Black and African American neighborhoods of North St. Louis City and North St. Louis County. Current testing criteria prioritizes individuals with severe symptoms. However, stakeholders have emphasized additional testing resources should be directed to areas with high prevalence of chronic conditions known to exacerbate COVID-19.
“Many factors have been identified as increasing risk for COVID-19, and associated mortality and morbidity,” said Will Ross, M.D., coauthor and Associate Dean for Diversity at the Washington University School of Medicine. “This research indicates race is a powerful factor in identification as well.”
Timothy McBride, PhD
Bernard Becker Professor and
Co-Director of the Center for Health Economics and Policy
Angela Brown, MPH
Saint Louis Regional Health Commission