Racial disparities in COVID-19 deaths in Georgia.

The 2019 novel coronavirus disease (COVID-19) has brought to the forefront racial disparities in health outcomes across the US, but there is limited formal analysis into factors associated with these disparities. In-depth examination of COVID-19 disparities has been challenging due to inconsistent case definition, isolation procedures, and incomplete racial and medical information. As of June 2020, over 14,000 (25%) confirmed COVID-19 cases in Georgia did not have racial information. However, nearly all COVID-19 deaths had racial and ethnic information for analysis. Using county-level information from the Georgia Department of Public Health and the national County Health Rankings & Roadmaps, we found that Black Americans represented 31.5% of all Georgia residents but 46% of COVID-19 deaths. In the metropolitan Atlanta area, this over-representation was most pronounced in Fulton County which houses the City of Atlanta. The opposite pattern - worse disparity in counties surrounding the central city-bearing county - was instead observed in Albany, Columbus, and Macon, with no significant disparity difference in counties surrounding Savannah. Principal component analysis of health-related outcomes and social determinants of health from these 46 counties identified 17 themes, with greater racial disparities in COVID-19 deaths associated with worse air pollution, more rural communities, and paradoxically greater adherence to guidelines for screening mammography. We conclude that factors associated with the virus responsible for COVID-19 and healthcare disproportionately impact Black Americans.