Neighborhood income and other structural factors have significant impacts on whether an individual in the area has been infected with or died from COVID-19, a new national study finds.

Areas with high populations of marginalized and minoritized populations that have historically been disinvested in were the hardest hit by the virus early in the pandemic, according to the research letter, “Assessment of Community-Level Disparities in Coronavirus Disease 2019 (COVID-19) Infections and Deaths in Large US Metropolitan Areas,” published in JAMA Network Open.

The research looked at data from the combined statistical areas (CSAs) of 10 major U.S. cities – Atlanta, Boston, Chicago, Detroit, Los Angeles, Miami, New Orleans, New York City, Philadelphia and Seattle. Learn more about states tracking COVID-19 race and ethnicity data.

In counties where the population was substantially non-white with a median income defined as $60,240, the COVID-19 death rate was more than nine times higher when compared to counties that are substantially white with the same median income. And the infection rate was nearly eight times higher for the more racially and ethnically diverse counties that authors called “more-poverty areas.” More investigation needs to be done to understand why there is inequitable access to opportunities and resources that cause non-whites to have lower incomes.

But racial inequities  didn’t disappear in higher-income counties where the median income was $79,834, which means that larger structural factors are at play that cause marginalized and minoritized groups to have worse outcomes. The COVID-19 infection and death rates were nearly three times higher in substantially non-white counties with higher median incomes when compared to substantially white, higher income counties that study authors called “less-poverty counties.”

“We knew from news reports and other smaller studies that have been coming out here and there that the African-American population, the Latino population and South Asian communities were being hit pretty hard by the virus,” said the study’s corresponding author Samrachana Adhikari, PhD, an assistant professor in the Division of Biostatistics within the Department of Population Health at New York University Grossman School of Medicine.

“But looking at the high-poverty areas, they were being hit nine times higher and that was a stark number. The differences in less-poverty areas is pretty stunning and it surprised us as well,” said Adhikari, adding that there is no biological or genetic basis for why these inequities would exist.