Mumbi E Kimani1, Mare Sarr2,3, Yendelela Cuffee4, Chang Liu5, Nicole S Webster6. 1. School of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa. 2. School of International Affairs, Pennsylvania State University, University Park. 3. School of Economics, University of Cape Town, Rondebosch, South Africa. 4. College of Health Sciences, University of Delaware, Newark. 5. College of Education, Pennsylvania State University, University Park. 6. College of Agricultural Sciences, Pennsylvania State University, University Park.
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.
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-19infection rates through a race/ethnicity lens. Objective: To examine the associations of race/ethnicity and past experiences of food insecurity with COVID-19infection 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-19infection 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-19infections 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-19infection 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-19infection 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-19infections 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-19infection rates in the United States. These findings suggest that the channels through which various racial/ethnic minority population concentrations were associated with COVID-19infection rates were markedly different during the pandemic.
Authors: Meredith T Niles; Alyssa W Beavers; Lauren A Clay; Marcelle M Dougan; Giselle A Pignotti; Stephanie Rogus; Mateja R Savoie-Roskos; Rachel E Schattman; Rachel M Zack; Francesco Acciai; Deanne Allegro; Emily H Belarmino; Farryl Bertmann; Erin Biehl; Nick Birk; Jessica Bishop-Royse; Christine Bozlak; Brianna Bradley; Barrett P Brenton; James Buszkiewicz; Brittney N Cavaliere; Young Cho; Eric M Clark; Kathryn Coakley; Jeanne Coffin-Schmitt; Sarah M Collier; Casey Coombs; Anne Dressel; Adam Drewnowski; Tom Evans; Beth J Feingold; Lauren Fiechtner; Kathryn J Fiorella; Katie Funderburk; Preety Gadhoke; Diana Gonzales-Pacheco; Amelia Greiner Safi; Sen Gu; Karla L Hanson; Amy Harley; Kaitlyn Harper; Akiko S Hosler; Alan Ismach; Anna Josephson; Linnea Laestadius; Heidi LeBlanc; Laura R Lewis; Michelle M Litton; Katie S Martin; Shadai Martin; Sarah Martinelli; John Mazzeo; Scott C Merrill; Roni Neff; Esther Nguyen; Punam Ohri-Vachaspati; Abigail Orbe; Jennifer J Otten; Sondra Parmer; Salome Pemberton; Zain Al Abdeen Qusair; Victoria Rivkina; Joelle Robinson; Chelsea M Rose; Saloumeh Sadeghzadeh; Brinda Sivaramakrishnan; Mariana Torres Arroyo; McKenna Voorhees; Kathryn Yerxa Journal: Curr Dev Nutr Date: 2021-11-01