Disparities in COVID-19 Incidence, Knowledge, Behavior

Jun 23, 2020
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Authors:
Alsan M, Stantcheva S, Yang D, Cutler D.
Citation:
Disparities in Coronavirus 2019 Reported Incidence, Knowledge, and Behavior Among US Adults. JAMA Netw Open 2020;3:e2012403.
Summary By:
Monica M. Colvin, MD, FACC

Quick Takes

  • African Americans, men, individuals <55 years old, and Republicans report higher exposure to COVID-19 but demonstrate less knowledge about its symptoms and transmission.
  • Behaviors related to mitigating spread of COVID-19 are reported less often by men, younger individuals (18-29 years), and African Americans.
  • Five percent of respondents believe COVID-19 to be a hoax.

Study Questions:

Do the reported incidence, knowledge, and behaviors regarding coronavirus disease 2019 (COVID-19) vary by sociodemographic characteristics in the United States?

Methods:

Between March 29 and April 13, 2020, a nine-question internet survey was conducted. Eighty percent of respondents were sampled from geographic areas according to population representation and 20% were sampled from COVID-19 hotspots. Questions assessed direct interaction with COVID-19, knowledge regarding transmission and symptoms, and behavior to mitigate the spread. Association with demographic and socioeconomic variables and political party affiliation were analyzed and compared using linear regression.

Results:

The survey included 5,198 individuals. The mean age was 48 years, 45% were men, 72% white, 16% African American, and 12% Hispanic. The sample was representative of the US population with the exception of a higher representation of unemployed individuals (14%) and college graduates (51%) in the study sample than in the US population. Knowledge of transmission, behaviors, and reported incidence varied by age, sex, race/ethnicity, and political affiliation. African Americans, men, individuals <55 years old, and Republicans were more likely to report exposure (having or knowing someone with COVID-19) to COVID-19. Increasing income was associated with knowing someone with COVID-19. More than 80% of the study sample was knowledgeable about transmission and symptoms of COVID-19. Five percent believed COVID-19 to be a hoax. African Americans, men, younger individuals, and Republicans demonstrated less knowledge about symptoms and spread. Men and individuals age 18-29 years washed their hands less frequently, and African Americans and men were more likely to leave their homes.

Conclusions:

In this survey, race/ethnicity, age, and sex differences in reported prevalence, knowledge, and behavior regarding COVID-19 exist. Efforts are needed to encourage appropriate behavior and dissemination of accurate information to help prevent infection and spread of COVID-19.

Perspective:

Exposure to COVID-19, knowledge of transmission and symptoms, and behavior to mitigate spread, vary by ethnicity/race, age, and sex. While efforts to improve knowledge and behavior are needed, they may be limited by socioeconomic factors, such as requirement to work outside the home, use of public transportation, and access to information.

Clinical Topics: COVID-19 Hub, Prevention

Keywords: African Americans, Coronavirus, COVID-19, Ethnic Groups, Hispanic Americans, Incidence, Internet, Political Systems, Prevalence, Surveys and Questionnaires, Secondary Prevention, severe acute respiratory syndrome coronavirus 2, Socioeconomic Factors


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