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Existing health disparities based on race and ethnicity in the United States are contributing to disparities in morbidity and mortality during the coronavirus disease (COVID-19) pandemic. We conducted an online survey of American adults to assess similarities and differences by race and ethnicity with respect to COVID-19 symptoms, estimates of the extent of the pandemic, knowledge of control measures, and stigma.
The aim of this study was to describe similarities and differences in COVID-19 symptoms, knowledge, and beliefs by race and ethnicity among adults in the United States.
We conducted a cross-sectional survey from March 27, 2020 through April 1, 2020. Participants were recruited on social media platforms and completed the survey on a secure web-based survey platform. We used chi-square tests to compare characteristics related to COVID-19 by race and ethnicity. Statistical tests were corrected using the Holm Bonferroni correction to account for multiple comparisons.
A total of 1435 participants completed the survey; 52 (3.6%) were Asian, 158 (11.0%) were non-Hispanic Black, 548 (38.2%) were Hispanic, 587 (40.9%) were non-Hispanic White, and 90 (6.3%) identified as other or multiple races. Only one symptom (sore throat) was found to be different based on race and ethnicity (
We observed differences with respect to knowledge of appropriate methods to prevent infection by the novel coronavirus that causes COVID-19. Deficits in knowledge of proper control methods may further exacerbate existing race/ethnicity disparities. Additional research is needed to identify trusted sources of information in Hispanic and non-Hispanic Black communities and create effective messaging to disseminate correct COVID-19 prevention and treatment information.
A novel coronavirus, severe acute respiratory syndrome 2 (SARS-CoV-2), was identified in Wuhan, China, in December 2019; the virus quickly spread worldwide and was labeled a pandemic by the World Health Organization on March 11, 2020 [
Racial and ethnic disparities in COVID-19 occurrence may be due to multiple factors. Asian, Black, and Hispanic Americans are all more likely to be uninsured than non-Hispanic White Americans [
Advertisements on Facebook, Snapchat, and Twitter were used to conduct a nationwide web-based survey with US adults aged 18 years or older from March 27 through April 1, 2020 [
The survey included questions on knowledge of effective prevention methods, a COVID-19 stigma scale, and current COVID-19–related symptoms (see
A total of 1435 participants consented to participate and completed the survey. Of the 1435 participants, 52 (3.6%) were Asian, 548 (38.2%) were Hispanic, 158 (11.0%) were non-Hispanic Black, 587 (40.9%) were non-Hispanic White, and 90 (6.3%) were of other or multiple races. There were race and ethnicity differences in gender, annual income, educational status, and geographic region of residence across categories of race and ethnicity (
When asked whether they were currently experiencing symptoms possibly related to COVID-19, a plurality of participants (635/1435, 44.3%) reported no symptoms (
When asked about their knowledge of numbers of cases and COVID-19 deaths, non-Hispanic White (376/587, 64.1%) and Asian (32/52, 61.5%) participants were more likely to correctly estimate that there were currently 100,000 or more cases in the US compared to Hispanic (269/548, 49.1%) and non-Hispanic Black (73/158, 46.2%) participants. No differences were observed in the estimated number of deaths expected from COVID-19 by the end of 2020.
Non-Hispanic White (180/587, 30.7%) and Asian (13/52, 25.0%) participants were more likely to answer all 14 COVID-19 knowledge scale questions correctly compared to Hispanic (108/548, 19.7%) and non-Hispanic Black (25/158, 15.8%) participants. Overall, 46.6% of participants endorsed at least one stigmatizing statement related to COVID-19, with no difference by race.
Overall, 954/1247 participants (76.5%) indicated willingness to participate in future research studies of diagnostic and serologic testing for SARS-CoV-2, with no differences by race and ethnicity.
Demographic characteristics of participants in a cross-sectional web-based survey of COVID-19 symptoms and knowledge from March 27 through April 1, 2020 (N=1435).
Characteristic | Total |
Asian |
Hispanic |
Non-Hispanic Black |
Non-Hispanic White |
Other/multiple race |
||
Age (years), median (IQR) | 33 (24-57) | 25 (21-31) | 30 (22-44) | 25 (20-38) | 54 (31-64) | 31 (21-58) | .002 | |
|
.002 | |||||||
|
Male | 536 (40.2) | 20 (41.7) | 236 (48.4) | 49 (36.8) | 202 (34.4) | 29 (37.7) |
|
|
Female | 761 (57.1) | 26 (54.2) | 249 (51.0) | 83 (62.4) | 360 (61.3) | 43 (55.8) |
|
|
Other | 36 (2.7) | 2 (4.2) | 3 (0.6) | 1 (0.8) | 25 (4.3) | 5 (6.5) |
|
|
.002 | |||||||
|
<30,000 | 376 (36.1) | 9 (25.7) | 150 (41.3) | 54 (49.1) | 139 (29.3) | 24 (40.7) |
|
|
30,000-74,999 | 397 (38.1) | 12 (34.3) | 127 (35.0) | 43 (39.1) | 192 (40.5) | 23 (39.0) |
|
|
≥75,000 | 268 (25.7) | 14 (40.0) | 86 (23.7) | 13 (11.8) | 143 (30.2) | 12 (20.3) |
|
|
.004 | |||||||
|
High school or less | 202 (16.7) | 5 (10.4) | 99 (22.9) | 15 (11.8) | 69 (12.9) | 14 (19.4) |
|
|
At least some college | 1011 (83.4) | 43 (89.6) | 333 (77.1) | 112 (88.2) | 465 (87.1) | 58 (80.6) |
|
|
.002 | |||||||
|
Midwest | 280 (19.6) | 7 (13.5) | 57 (10.4) | 27 (17.1) | 177 (30.3) | 12 (13.3) |
|
|
Northeast | 251 (17.5) | 9 (17.3) | 82 (15.0) | 22 (13.9) | 117 (20.0) | 9 (17.3) |
|
|
South | 540 (37.7) | 8 (15.4) | 215 (39.4) | 86 (54.4) | 200 (34.2) | 8 (15.4) |
|
|
West | 360 (25.2) | 28 (53.9) | 192 (35.2) | 23 (14.6) | 91 (15.6) | 28 (53.9) |
|
aHolm Bonferroni
bCategory totals do not sum to the total of 1435 due to missing data.
Associations between race/ethnicity and symptoms, likelihood of current COVID-19 infection, estimates of the extent of the COVID-19 pandemic, knowledge, stigma, and interest in participating in research studies among participants in a web-based, cross-sectional survey conducted from March 27 through April 1, 2020 (N=1435).
Variable | Total |
Asian |
Hispanic |
Non-Hispanic Black |
Non-Hispanic White |
Other/multiple race |
||
|
||||||||
|
Fever | 35 (2.4) | 1 (1.9) | 10 (1.8) | 6 (3.8) | 13 (2.2) | 5 (5.6) | >.99 |
|
Cough | 328 (22.9) | 9 (17.3) | 119 (21.7) | 30 (19.0) | 159 (27.1) | 11 (12.2) | .07 |
|
Sneezing | 322 (22.4) | 11 (21.2) | 124 (22.6) | 37 (23.4) | 129 (22.0) | 21 (23.3) | >.99 |
|
Sore throat | 214 (14.9) | 3 (5.8) | 99 (18.1) | 9 (5.7) | 95 (16.2) | 8 (8.9) | .003 |
|
Headache | 311 (21.7) | 10 (19.2) | 110 (20.1) | 43 (27.2) | 127 (21.6) | 21 (23.3) | >.99 |
|
Shortness of breath | 94 (6.6) | 3 (5.8) | 31 (5.7) | 5 (3.2) | 47 (8.0) | 8 (8.9) | >.99 |
|
Diarrhea | 108 (7.5) | 3 (5.8) | 42 (7.7) | 9 (5.7) | 47 (8.0) | 7 (7.8) | >.99 |
|
Myalgia | 103 (7.2) | 2 (3.9) | 36 (6.6) | 7 (4.4) | 54 (9.2) | 4 (4.4) | >.99 |
|
Feeling of being unwell | 175 (12.2) | 8 (15.4) | 69 (12.6) | 17 (10.8) | 70 (11.9) | 11 (12.2) | >.99 |
|
No symptoms | 635 (44.3) | 23 (44.2) | 246 (44.9) | 75 (47.5) | 251 (42.8) | 40 (44.4) | >.99 |
|
.002 | |||||||
|
Very unlikely | 356 (25.0) | 8 (15.7) | 129 (23.7) | 37 (23.6) | 157 (27.1) | 25 (27.8) |
|
|
Unlikely | 661 (46.5) | 32 (62.8) | 223 (41.0) | 66 (42.0) | 302 (52.1) | 38 (42.2) |
|
|
Somewhat likely | 324 (22.8) | 9 (17.7) | 149 (27.4) | 41 (26.1) | 103 (17.8) | 22 (24.4) |
|
|
Likely | 47 (3.3) | 2 (3.9) | 24 (4.4) | 10 (6.4) | 9 (1.6) | 2 (2.2) |
|
|
Very likely | 34 (2.4) | 0 (0.0) | 19 (3.5) | 3 (1.9) | 9 (1.6) | 3 (3.3) |
|
|
.004 | |||||||
|
<1000 | 28 (2.0) | 1 (1.9) | 14 (2.6) | 4 (2.5) | 9 (1.5) | 0 (0.0) |
|
|
1000-9999 | 496 (34.6) | 17 (32.7) | 215 (39.2) | 72 (45.6) | 157 (26.8) | 35 (38.9) |
|
|
10,000-99,999 | 113 (7.9) | 2 (3.9) | 50 (9.1) | 9 (5.7) | 45 (7.7) | 7 (7.8) |
|
|
100,000-499,999 | 458 (31.9) | 18 (34.6) | 161 (29.4) | 43 (27.2) | 209 (35.6) | 27 (30.0) |
|
|
500,000-999,999 | 139 (9.7) | 3 (5.8) | 52 (9.5) | 8 (5.1) | 69 (11.8) | 7 (7.8) |
|
|
≥1,000,000 | 201 (14.0) | 11 (21.2) | 56 (10.2) | 22 (13.9) | 98 (16.7) | 14 (15.6) |
|
|
>.99 | |||||||
|
Fewer than 1000 | 55 (4.0) | 2 (4.0) | 20 (3.9) | 8 (5.1) | 20 (3.6) | 5 (6.0) |
|
|
1000-10,000 | 266 (19.5) | 8 (16.0) | 82 (15.8) | 38 (24.2) | 125 (22.6) | 13 (15.5) |
|
|
10,001-100,000 | 478 (35.0) | 16 (32.0) | 184 (35.4) | 54 (34.4) | 194 (35.0) | 30 (35.7) |
|
|
100,000-1,000,000 | 430 (31.5) | 17 (34.0) | 186 (35.8) | 48 (30.6) | 152 (27.4) | 27 (32.1) |
|
|
≥1,000,000 | 136 (10.0) | 7 (14.0) | 48 (9.2) | 9 (5.7) | 63 (11.4) | 9 (10.7) |
|
|
.002 | |||||||
|
<12 | 418 (29.1) | 13 (25.0) | 196 (35.8) | 61 (38.6) | 116 (19.8) | 32 (35.6) |
|
|
12-13 | 675 (47.0) | 26 (50.0) | 244 (44.5) | 72 (45.6) | 291 (49.6) | 42 (46.7) |
|
|
14 | 342 (23.8) | 13 (25.0) | 108 (19.7) | 25 (15.8) | 180 (30.7) | 16 (17.8) |
|
|
.09 | |||||||
|
0 | 722 (53.4) | 31 (62.0) | 242 (47.1) | 71 (48.6) | 329 (59.2) | 49 (56.3) |
|
|
1-2 | 525 (38.8) | 16 (32.0) | 221 (43.0) | 65 (44.5) | 191 (34.4) | 32 (36.8) |
|
|
≥3 | 106 (7.8) | 3 (6.0) | 51 (9.9) | 10 (6.9) | 36 (6.5) | 6 (6.9) |
|
|
>.99 | |||||||
|
Yes | 954 (76.5) | 35 (72.9) | 352 (78.4) | 94 (71.2) | 416 (76.5) | 57 (77.0) |
|
|
No | 293 (23.5) | 13 (27.1) | 97 (21.6) | 38 (28.8) | 128 (23.5) | 17 (23.0) |
|
aHolm Bonferroni
bCOVID-19: coronavirus disease.
cCategory total does not sum to the column total due to missing data.
dValues greater than the population of the United States (328 million) were excluded. At the beginning of the study period (March 27, 2020), there were 107,000 cumulative confirmed cases in the United States. At the end of the study period (April 1, 2020), there were 213,400 cumulative confirmed cases in the United States.
We observed few differences in prevalent symptoms consistent with COVID-19 among a web-based sample of adults in the United States at the end of March through the beginning of April 2020. With respect to estimating the extent of the epidemic in the United States during the study period, there were 101,700 cumulative confirmed cases and 1600 cumulative deaths as of March 27, 2020 and 213,400 cumulative confirmed cases and 5000 cumulative deaths by April 1, 2020 [
Despite the similarity in experiences of COVID-19 symptoms, we did observe differences in participants’ self-assessed likelihood of having COVID-19 at the time of survey completion. Hispanic and non-Hispanic Black participants were more likely to suspect that they were currently infected, which may reflect an awareness of the differential impact of the pandemic on communities of color in the United States or a better understanding of the potential for asymptomatic infection. These differential self-assessments of the likelihood of current infection may translate to differential testing and care-seeking behavior. Trends in self-assessment of symptoms and knowledge of appropriate prevention strategies should be continuously monitored to identify any persistent differences based on race and ethnicity.
This study has limitations. Participants were recruited on the internet via advertisements on social media sites and are not representative of all adults in the United States. Participation in an uncompensated survey may reflect a prior interest in COVID-19; therefore, the respondents may have more COVID-19 knowledge compared to the general population. However, we do not think that this selection bias would be differential by race or ethnicity.
Racial and ethnic disparities in morbidity and mortality due to COVID-19 are already apparent. Black and Hispanic populations bear a disproportionate burden of medical conditions across their lifespans, including obesity, diabetes, and heart disease [
Addressing the structural racism that results in differential access to care will necessarily involve structural changes to health care delivery [
Full survey.
coronavirus disease
severe acute respiratory syndrome 2
We appreciate and acknowledge the contributions of our study participants. This work was supported by the National Institute of Allergy and Infectious Diseases (3R01AI143875-02S1). The study was facilitated by the Center for AIDS Research at Emory University (P30AI050409). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
All authors had full access to study data, and JJ and AJS had final responsibility for the decision to submit for publication.
None declared.