Socioeconomic Status as a Risk Factor in Economic and Physical Harm from COVID-19: Evidence from the United States

• Published date: 01 November 2021
• Author: Jonathan Rothwell,Ember Smith
• DOI: 10.1177/00027162211062137
• Date: 01 November 2021

12 ANNALS, AAPSS, 698, November 2021

DOI: 10.1177/00027162211062137

Socioeconomic

Status as a Risk

Factor in

Economic and

Physical

Harm from

COVID-19:

Evidence from

the United

States

By

JONATHAN ROTHWELL

and

EMBER SMITH

1062137ANN THE ANNALS OF THE AMERICAN ACADEMYSES AS A RISK FACTOR IN HARM FROM COVID-19

research-article2021

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 associ-

ated 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.

Keywords: COVID-19; socioeconomic status; ine-

quality; social determinants of health;

health

Even with widespread business and school

closures, as well as restrictions on social

gatherings, twenty million Americans had

tested positive for COVID-19 by the end of

2020. While the pandemic’s damage has been

widespread within the United States, evidence

has emerged that economic and physical harm

have been disproportionately concentrated in

groups with lower socioeconomic status, such

as Black and Hispanic Americans, raising

important policy issues about equity during this

and future pandemics. This article documents

these trends systematically within the United

Jonathan Rothwell is Gallup’s principal economist, a

nonresident senior fellow at the Brookings Institution,

and a visiting scholar at George Washington University.

Ember Smith is a senior research assistant at the

Brookings Institution.

Correspondence: Jonathan_Rothwell@gallup.com

SES AS A RISK FACTOR IN HARM FROM COVID-19 13

States using the best available data, comparing the gradient between harm and

socioeconomic status.

This article adds to the literature in several important ways. First, we rely on

large-scale, high-quality public and private data to measure harm at the individ-

ual level, in terms of economic hardship and exposure to the disease. The breadth

and depth of these data clarify relationships found in the broader literature and

allow for more direct comparisons across demographic groups. Second, in the

absence of comprehensive individual data that links the disease burden to educa-

tion and income, we create and analyze a new database of zip code–level infec-

tions and deaths from a variety of public health departments. We analyze both

the raw data and imputations to missing zip codes, adding further evidence to the

discussion.

We uncover clear and consistent evidence that education, income, and race

are all strongly predictive of the disease and economic burdens of the pandemic.

For the disease burden of COVID-19, our preferred estimates show that the risk

of infection and hospitalization is 2.9 and 3.4 times higher, respectively, for poor

Americans (defined by Medicaid eligibility) compared to nonpoor Americans.

These rates are comparable to racial and ethnic gaps in the rate of severe cases

(hospitalization and deaths), but those gaps essentially disappear among poor

individuals, suggesting that racial differences in the disease burden are driven by

characteristics better captured by income. Our zip code database also suggests

that education is highly predictive of infection and deaths rates, and the effect of

zip code educational attainment is comparable to the effect of the zip code’s

racial composition.

In our preferred estimates of the economic burden, Hispanic and Black work-

ers were 31 percent to 41 percent more likely, respectively, to face income losses

related to the pandemic than white workers. Meanwhile, workers with a high

school diploma or less education were 56 percent more likely to lose income

compared to workers with a graduate degree. Those in the lowest household

income category were 100 percent more likely to lose income compared to those

in the top income category.

Finally, we use Gallup survey data to contribute to the discussion of why the

relationship between socioeconomic status and disease burden exists. We find

that self-reported social distancing and mask usage do not vary much across

socioeconomic status and do not explain the disproportionate economic or physi-

cal outcomes. If anything, we find that Black and Hispanic adults are more likely

to comply with public health recommendations on social distancing and mask

usage than white Americans, which is not surprising given the partisan differ-

ences in these behaviors documented elsewhere (Makridis and Rothwell 2020).

Rather, we show preliminary evidence that occupation- and industry-based expo-

sure to layoffs and infection risk are disproportionately high in populations with

lower socioeconomic status.