Factors Associated with COVID-Related Mortality: the Case of Texas

Background: Texas ranks 2nd in the count of COVID cases. Pre-existing disparities in healthcare may be intersecting with COVID-19 outcomes. Objectives: To explore the relationship between county-level race/ethnic composition and COVID-19 mortality in the state of Texas and determine whether county-level health factors, healthcare access measures, and other demographic characteristics explain this relationship. Methods: This retrospective study uses county-level case and fatality data obtained from the Texas Department of State Health Services and merged with the 2020 Robert Wood Johnson foundation (RWJF) county health rankings data. The outcome variables were fatalities per 100,000 population. A two-part/hurdle model examined (1) the probability of having a COVID-19 fatality and (2) fatalities per 100,000 population in counties with 1+ fatalities. For both parts of the hurdle model, we examined the impacts of racial and ethnic composition, adjusting for county characteristics and health factors. Results: The odds of having a COVID-19 fatality decreased with a unit increase in the rate of primary care physicians in a county (OR = 0.93; 95% CI = 0.89, 0.99). In the second part of the model, there was a statistically significant increase in COVID-19 fatalities/100,000 population with every 1 % increase in the proportion of Hispanics (β = 5.41; p = 0.03) and African Americans (β = 5.08; p value = 0.04). Conclusion: Counties with higher rates of minorities, specifically Hispanics and African Americans, have a higher COVID-19 fatality burden. Targeted interventions are needed to raise awareness of preventive measures in these communities.