Race, explicit racial attitudes, implicit racial attitudes, and COVID-19 cases and deaths: An analysis of counties in the United States.

Objectives To examine the potential moderating effects of explicit racial attitudes and implicit racial attitudes on the relationship between percent of Black county residents and COVID-19 cases and deaths. Methods We collected data from a variety of publicly available sources for 817 counties in the US. (26% of all counties). Cumulative COVID-19 deaths and cases from January 22 to August 31, 2020 were the dependent variables; explicit racial attitudes and implicit racial attitudes served as the moderators; subjective poor or fair health, food insecurity, percent uninsured, percent unemployed, median family income, percent women, percent of Asian county resident, percent of Hispanic county residents, and percent of people 65 or older were controls. Results The percent of Black county residents was positively associated with COVID-19 cases and deaths at the county level. The relationship between percent of Black residents and COVID-19 cases was moderated by explicit racial attitudes and implicit racial attitudes. Conclusions Implicit racial attitudes can take on a shared property at the community level and effectively explain racial disparities. COVID-19 cases are highest when both the percent of Black county residents and implicit racial attitudes are high.