A University of South Florida (USF) epidemiology associate professor discovered associations between COVID-19 mortality rates and socioeconomic position, gender, ethnicity and race that reveal an urgent need to implement population-based infection control efforts, especially for those in low socioeconomic positions (SEP).
In collaboration with a team of epidemiologists from the COVKID Project, USF College of Public Health Associate Professor Jason Salemi launched a national investigation into COVID-19 deaths in 2020 with data released by the U.S. National Center for Health Statistics.
The study, published in the International Journal of Environmental Research and Public Health, analyzed nearly 70,000 adults, ages 25 to 64, who died from COVID-19. The team found 68% of COVID-19 deaths the first year of the pandemic were low SEP adults employed in labor, service and retail jobs that require on-site attendance and prolonged close contact with others.
“The degree to which it takes a toll on communities is very unevenly distributed and we wanted to call attention to that issue,” Salemi said.
The National Center for Health Statistics uses one’s level of education as a measure of socioeconomic status because it is considered to be a more stable indicator of SEP over time. In tandem, the team categorized each person’s SEP by their level of education – low SEP adults had no education beyond high school, intermediate SEP had at least one year of college attendance and high SEP adults had at minimum a bachelor’s degree.
The findings reveal a person’s level of education is strongly associated with occupation segregation – with the majority of low SEP adults employed in working-class jobs across all gender, race and ethnicity groups in the United States.
Historically, data shows the working class experiences disproportionate exposure risks and increased burden of disease.
COVID-19 proved no different. Salemi and the team confirmed hazardous conditions of work, like working in close proximity with others, were primary drivers of disparities in COVID-19 mortality rates.
Elevated infection risks are amplified across multiple social environmental scales for working-class adults, especially when compared to high SEP workers who are more likely to have fewer exposure risks, options to work remotely, paid sick leave and better access to quality health care.
“If we were to immediately heed the calls to return to ‘normal’ and stop worrying about community spread of the virus, there are certain subsets and members of our community that are going to suffer way more so than other members – and these people have already borne the disproportioned brunt of this pandemic,” Salemi said.
Since 2020, about 78% of people in the United States have received at least one dose of a COVID-19 vaccine, but the number of COVID-19 cases is trending upward once again. The Centers for Disease Control and Prevention are asking people to practice prevention strategies based on their county COVID-19 Community Levels to protect high risk populations.
Salemi’s study shows the mortality rate of low SEP adults is five times higher when compared to high SEP adults, and the mortality rate of intermediate SEP adults is two times higher. White women make up the largest population group considered high SEP. In contrast, nearly 60% of Hispanic men are in a low SEP. When compared, the mortality rate of low SEP Hispanic men is 27 times higher than high SEP white women.
As a result, Salemi says the most urgent implication of this study points to immediate actions needed to protect the working class from infection by strengthening federal and state labor laws, empowering the U.S. Occupational Safety and Health Administration, adopting safety and health hazard policies and allowing unions to organize for greater protections for worker safety.
Salemi hopes to expand on this study with mortality data from 2021 and beyond but knows the message will remain the same: “Return to normal” does not mean the same thing for everyone.