Empirical evidence on structural racism as a driver of racial inequities in COVID-19 mortality.
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2022-01
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This study contributes to the literature by empirically testing the extent to which place-based structural racism is a driver of state-level racial inequalities in COVID-19 mortality using theoretically-informed, innovative approaches.Methods
CDC data are used to measure cumulative COVID-19 death rates between January 2020 and August 2022. The outcome measure is a state-level Black-White (B/W) ratio of age-adjusted death rates. We use state-level 2019 administrative data on previously validated indicators of structural racism spanning educational, economic, political, criminal-legal and housing to identify a novel, multi-sectoral latent measure of structural racism (CFI = 0.982, TLI = 0.968, and RMSEA = 0.044). We map B/W inequalities in COVID-19 mortality as well as the latent measure of structural racism in order to understand their geographic distribution across U.S. states. Finally, we use regression analyses to estimate the extent to which structural racism contributes to Black-White inequalities in COVID-19 mortality, net of potential confounders.Results
Results reveal substantial state-level variation in the B/W ratio of COVID-19 death rates and structural racism. Notably, regression estimates indicate that the relationship between the structural racism and B/W inequality in COVID-19 mortality is positive and statistically significant (p < 0.001), both in the bivariate model (adjusted R2 = 0.37) and net of the covariates (adjusted R2 = 0.54). For example, whereas states with a structural racism value 2 standard deviation below the mean have a B/W ratio of approximately 1.12, states with a structural racism value 2 standard deviation above the mean have a ratio of just above 2.0.Discussion
Findings suggest that efficacious health equity solutions will require bold policies that dismantle structural racism across numerous societal domains.Type
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Brown, Tyson H, Christina Kamis and Patricia Homan (2022). Empirical evidence on structural racism as a driver of racial inequities in COVID-19 mortality. Frontiers in public health, 10. p. 1007053. 10.3389/fpubh.2022.1007053 Retrieved from https://hdl.handle.net/10161/26397.
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Tyson Brown
Tyson H. Brown is Professor of Sociology and Medicine at Duke University. A medical sociologist, race scholar, and population health scientist, his work integrates innovative theoretical frameworks with advanced data science and statistical methods to investigate the causes and consequences of racial inequality (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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