Regional variation in COVID-19 disparities: Connections with immigrant and Latinx communities in US counties.

PURPOSE: To evaluate associations between counties' COVID-19 cases and racial-ethnic and nativity composition, considering heterogeneity across Latin American-origin subgroups and regions of the U.S. METHODS: Using county-level data and multi-level negative binomial models, we evaluate associations between COVID-19 cases and percentages of residents that are foreign-born, Latinx, Black, or Asian, presenting estimates for all counties combined and stratifying across regions. Given varying risk factors among Latinx, we also evaluate associations for percentages of residents from specific Latin American-origin groups. RESULTS: Percentage of foreign-born residents is positively associated with COVID-19 case rate (IRR=1.106; 95%CI: 1.074-1.139). Adjusted associations for percentage Latinx are non-significant for all counties combined, but this obscures heterogeneity. Counties with more Central Americans have higher case rates (IRR=1.130; 95%CI: 1.067-1.197). And, in the Northeast and Midwest, counties with more Puerto Ricans have higher case rates. Associations with percentage Asians are non-significant after adjusting for percentage foreign-born. Confirming prior evidence, percentage of Black residents is positively and robustly associated with COVID-19 case rate (IRR=1.031; 95%CI: 1.025-1.036). CONCLUSIONS: Counties with more immigrants, as well as more Central American or Black residents have more COVID-19 cases. In the Northeast and Midwest, counties with more Puerto Rican residents also have more COVID-19 cases.