Overcrowding and COVID-19 mortality across U.S. counties: Are disparities growing over time?


A growing line of research underscores that sociodemographic factors may contribute to disparities in the impact of COVID-19. Further, stages of disease theory suggests that disparities may grow as the pandemic unfolds and more advantaged areas are better able to apply growing knowledge and mitigation strategies. In this paper, we focus on the role of county-level household overcrowding on disparities in COVID-19 mortality in U.S. counties. We examine this relationship across three theoretically important periods of the pandemic from April-October 2020, that mark both separate stages of community knowledge and national mortality levels. We find evidence that the percentage of overcrowded households is a stronger predictor of COVID-19 mortality during later periods of the pandemic. Moreover, despite a relationship between overcrowding and poverty at the county-level, overcrowding plays an independent role in predicting COVID-19 mortality. Our findings underscore that areas disadvantaged by overcrowding may be more vulnerable to the effects of COVID-19 and that this vulnerability may lead to changing disparities over time.





Published Version (Please cite this version)


Publication Info

Kamis, Christina, Allison Stolte, Jessica S West, Samuel H Fishman, Taylor Brown, Tyson Brown and Heather R Farmer (2021). Overcrowding and COVID-19 mortality across U.S. counties: Are disparities growing over time?. SSM - population health, 15. p. 100845. 10.1016/j.ssmph.2021.100845 Retrieved from https://hdl.handle.net/10161/28651.

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Jessica Sayles West

Medical Instructor in the Department of Head and Neck Surgery & Communication Sciences

Jessica is a medical sociologist who specializes in research on hearing loss, aging, and health disparities over the life course. Jessica’s work has described the “spillover” effects of hearing loss on health outcomes for both individuals and those close to them, as well as sociodemographic disparities in the onset of and life expectancy with hearing loss. Her research, which leverages both population-level data and electronic health record data, has appeared in the Journals of Gerontology, Social Science & Medicine, Ear and Hearing, and other leading journals in medical sociology, hearing, and aging research.

Jessica received a B.A. from the University of Michigan in Social Anthropology (dual Sociology/Anthropology concentration) followed by an M.P.H. in Sociomedical Sciences with a certificate in Public Health Research Methods from Columbia University’s Mailman School of Public Health. She subsequently received an M.A. and Ph.D. in Sociology with a focus in Medical Sociology and Demography at Duke University. She then completed an NIA T32 Postdoctoral Fellowship at the Duke University Aging Center under the mentorship of Matthew E. Dupre, Ph.D. (Population Health Sciences) and Sherri L. Smith, Au.D., Ph.D. (Head and Neck Surgery & Communication Sciences).


Tyson Brown

WLF Associate Professor of Sociology

Tyson H. Brown is an Associate Professor of Sociology and Medicine at Duke University, where he holds the W.L.F. endowed chair. He is a medical sociologist, race scholar, and demographer who uses novel theoretical and empirical approaches to examine the causes and consequences of racial inequality.

Dr. Brown’s research has resulted in highly-cited conceptual, empirical and agenda-setting articles in leading journals in the fields of sociology, demography, health policy, gerontology and population health (CV). His research contributions have been recognized with awards from the American Sociological Association and Duke University, as well as interdisciplinary collaborations with scholars across the country and with the National Academies. In addition, he was a resident fellow at Oxford University and the inaugural Duke Presidential Fellow. He has also been awarded funding for his training and research from the Robert Wood Johnson and Ford Foundations as well as the National Institutes of Health.

Professor Brown’s current program of research focuses on the scientific study of structural racism as a fundamental cause of health inequality. By developing theoretically-informed, innovative and rigorous methods for quantifying structural racism—across economic, educational, political, housing, and criminal-legal domains—and its effects on population health, his research provides empirical evidence on why racialized health inequities exist. Moreover, by mapping the geography of structural racism, his work identifies where racially discriminatory contexts are particularly severe and pernicious.

Brown is actively engaged in service at the university and national level. He has served in leadership position within professional organizations, including on the Board of Directors of the Population Association of America as well as on the editorial boards of top journals. Brown also founded and co-directs Duke's Writing, Research and Productivity (WRAP) Group, which aims to promote excellence in scholarship and support Black faculty by creating protected writing time and a space that enhances faculty inclusion. In addition, professor Brown enjoys serving as a mentor to Duke students and postdocs, as well as to early-career scientists, through programs funded by Russell Sage and Robert Wood Johnson Foundations to build the pipeline of future scholars.

Representative Publications:

Brown, Tyson H. and Patricia Homan. 2024. “Structural Racism and Health Stratification: Connecting Theory to Measurement.” Journal of Health and Social Behaviorhttps://doi.org/10.1177/0022146523122292

Brown, Tyson H., Taylor W. Hargrove, Patricia A. Homan and Daniel E. Adkins. 2023. “Racialized Health Inequities: Quantifying Socioeconomic and Stress Pathways Using Moderated Mediation.” Demography, 60(3): 675-705. https://doi.org/10.1215/00703370-10740718

Brown, Tyson H. and Patricia Homan. 2023. “The Future of Social Determinants of Health: Looking Upstream to Structural Drivers.” Milbank Quarterly, 101(S1): 36-60. https://doi.org/10.1111/1468-0009.12641

Brown, Tyson H., Christina Kamis and Patricia Homan. 2022. “Empirical Evidence on Structural Racism as a Driver of Racial Inequalities in COVID-19 Mortality.” Frontiers in Public Health. doi: 10.3389/fpubh.2022.1007053

Brown, Tyson H. and Patricia A. Homan. 2022. “Frontiers in Measuring Structural Racism and its Health Effects.” Health Services Review, 57(3): 443-447.

Homan, Patricia A. and Tyson H. Brown. 2022. “Sick and Tired of Being Excluded: Structural Racism in Disenfranchisement as a Threat to Population Health.” Health Affairs, 41(2): 219-227.

Hardeman, Rachel, Patricia Homan, Tongtan Chantarat, Brigette Davis and Tyson Brown. 2022. “We Can’t Change What We Don’t Measure: Improving Measurement of Structural Racism for Antiracist Health Policy Research.” Health Affairs, 41(2): 179-186.

Brown, Tyson H. 2018. “Racial Stratification, Immigration, and Health Inequality: A Life Course-Intersectional Approach.” Social Forces, 96(4):1507-1540.

Brown, Tyson H., Liana J. Richardson, Taylor W. Hargrove and Courtney S. Thomas. 2016. “Using Multiple-Hierarchy Stratification Approaches to Understand Health Inequalities: The Intersecting Consequences of Race, Gender, SES and Age.” Journal of Health and Social Behavior, 57(2):200-222.

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