Racial and Ethnic Disparities in Incidence of SARS-CoV-2 Infection, 22 US States and DC, January 1–October 1, 2020

H ealth disparities among racial/ethnic minority groups in the United States are closely related to structural inequities in social determinants of health.Some racial/ethnic minority groups have disproportionate rates of underlying conditions that increase the risk for severe illness from coronavirus disease (COVID-19) (1,2).Certain groups are overrepresented in occupations that require public contact, have crowded conditions, or are unamenable to telework, increasing the risk for exposure to severe acute respiratory infection coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19 (3,4).Structural inequities in housing, education, wealth, and healthcare access also increase disparities in infection and COVID-related illness and death (5-8).We conducted an intersectional analysis by race/ ethnicity, age, and sex to identify disparities in SARS-CoV-2 incidence using data from multiple US jurisdictions.Monitoring these disparities is critical for guiding action to reduce health inequities. The StudyWe analyzed SARS-CoV-2 infections reported to the Centers for Disease Control and Prevention (https:// data.cdc.gov/browse?tags=covid-19) by jurisdictional health departments.To minimize information bias, we included only jurisdictions reporting >30% of cases (https://protect-public.hhs.gov) and >70% completeness of race/ethnicity data of cases during January 1-October 1, 2020.We analyzed data on race/ethnicity, age, and sex in 1,751,627 cases from 22 US states and the District of Columbia (Table ).We determined cumulative incidence of infection per 100,000 population and cumulative incidence ratios (CIRs) with 95% CIs by race/ethnicity, age, and sex.Patients were grouped as Hispanic or Latino (Hispanic), non-Hispanic American Indian or Alaska Native (AIAN), non-Hispanic Black or African American (Black), non-Hispanic Asian (Asian), non-Hispanic Native Hawaiian or other Pacifi c Islander (NHOPI), non-Hispanic White (White), or non-Hispanic of multiple races (multiple race).Of Hispanic persons in this sample, 53.8% identifi ed as White, 33.2% as persons of multiple or other races, 1.7% as Black, 0.2% as Asian, and 0.2% as NHOPI; 10.5% of Hispanic persons were of unknown race.We used population denominators from the 2019 US Census (Annual County Resident Population Estimates by Age, Sex, Race, and Hispanic Origin, https://www.census.gov/programs-sur-veys/popest/technical-documentation/file-layouts.html).We considered CIR 95% CIs excluding 1.0 to be signifi cant.We assessed differences in rates by sex after adjusting for race/ethnicity and age using Analysis of Variance.We conducted statistical analyses using R version 4.0.0 (9).This study was conducted in Racial and Ethnic Disparities in Incidence of SARS-CoV-2 Infection, 22 US States and DC, January 1-October 1, 2020