Empirical evidence on structural racism as a driver of racial inequities in COVID-19 mortality.

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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.


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 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.


Findings suggest that efficacious health equity solutions will require bold policies that dismantle structural racism across numerous societal domains.





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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

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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