Overcrowding and COVID-19 mortality across U.S. counties: Are disparities growing over time?
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2021-09
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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.
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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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Scholars@Duke
Jessica Sayles West
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
Tyson H. Brown is Professor of Sociology and Medicine at Duke University, where he directs the Samuel DuBois Cook Center on Social Equity. A medical sociologist, race scholar, and population health scientist, his research integrates innovative theoretical frameworks with advanced data science and statistical methods to examine the causes, consequences, and solutions to racial inequality, with the aim of advancing knowledge, informing policy, and fostering a more equitable society (see personal website).
Dr. Brown’s research has led to high-impact publications in top journals across sociology, demography, gerontology, population health, and health policy (CV). His scholarly contributions have been recognized with awards from the American Sociological Association and Duke University, and his work has fostered interdisciplinary collaborations with scholars nationwide, including through engagements with the National Academies. He has held appointments as a resident fellow at Oxford University and as the inaugural Duke Presidential Fellow. His research and training have been supported by competitive grants from the Robert Wood Johnson Foundation, the Ford Foundation, and 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 both the university and national levels. At Duke, he has served on the Academic Council—Duke’s faculty senate—and on its Executive Committee, contributing to faculty governance and university-wide strategic planning. Nationally, he has held leadership roles in prominent professional organizations, including serving on the Board of Directors of the Population Association of America and on the editorial boards of leading scholarly journals. In addition to institutional service, Professor Brown is deeply committed to mentorship. He works closely with Duke students, postdoctoral fellows, and early-career scholars, including through programs supported by the Russell Sage Foundation and the Robert Wood Johnson Foundation that aim to strengthen the pipeline of future social scientists.
Representative Publications:
Brown Tyson H, Patricia Homan and Victor Ray. 2025. "Advancing the Scientific Study of Structural Racism: Concepts, Measures, and Methods." Annual Review of Sociology 51:24.1-24.23 https://doi.org/10.1146/annurev-soc-090924-021305
Brown, Tyson H., Hedwig E. Lee, Eduardo Bonilla-Silva, Margaret T. Hicken, and Patricia Homan. 2025. “Conceptualizing and Measuring Systemic Racism.” Annual Review of Public Health 46:28.1–28.22. https://doi.org/10.1146/annurev-publhealth-060222-032022
Research Agenda for Increasing Economic and Social Mobility in the United States. National Academies of Sciences, Engineering, and Medicine. 2025. Washington, DC: The National Academies Press. (co-author).
Brown, Tyson H. and Patricia Homan. 2024. “Structural Racism and Health Stratification: Connecting Theory to Measurement.” Journal of Health and Social Behavior. https://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
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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