Population-Level Disparities in Exposure to COVID-19 Mitigation Policies, April 2020-April 2021.

CONTEXT: Studies have found that COVID-19 stay-at-home orders (SHOs) and face mask policies (FMPs) were associated with reduced COVID-19 transmission and deaths. But it is unknown whether exposure to these policies varied by sociodemographic characteristics across the US population.

OBJECTIVE

The goal of this study was to quantify and characterize the sociodemographic characteristics and geographic distribution of populations exposed to evidence-based COVID-19 mitigation policies.

DESIGN

We obtained statewide SHOs and FMPs for all US counties from April 10, 2020, to April 10, 2021, calculated median policy lengths, and categorized counties into 4 groups based on length of policy exposure: low SHO-low FMP, high SHO-low FMP, low SHO-high FMP, and high SHO-high FMP. We described exposure groups by COVID-19 cumulative case/death and vaccination rates and county sociodemographic characteristics.

SETTING

In total, 3142 counties from all 50 states and Washington, District of Columbia, were included in the analysis.

MAIN OUTCOME MEASURES: County-level sociodemographic factors and county cumulative rates for COVID-19 cases, deaths, and vaccinations.

RESULTS

The largest percentage of the US population lived in counties with high exposure to SHOs and FMPs. However, populations living in high SHO-high FMP counties had the lowest percent non-Hispanic Black (NHB) and highest percent non-Hispanic White (NHW) populations. Populations living in high SHO-low FMP counties had the highest percent NHB and Hispanic populations and the lowest percent NHW population.

CONCLUSION

This study identified county-level racial, ethnic, and sociodemographic disparities in exposure to evidence-based statewide COVID-19 mitigation policies.

POLICY IMPLICATIONS: Exposure to evidence-based policies is an important consideration for studies evaluating the root causes of health inequities.