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COVID-19 disparities by county

The following charts summarize key COVID-19 disparities by sex, age group, and race/ethnicity. Ideally, comparisons across groups and geographies would use age-adjusted mortality rates to account for differences in the age structure of each group and geography, but the detailed data to calculate those rates is unavailable at this time. Drawing from San Antonio Metropolitan Health District analyses published in November 2020, the following charts visualize disparities by comparing the distribution or breakdown of COVID-19 indicators by sex, age group, and race/ethnicity with the distribution in the general population.

Sex distribution of Covid-19 test, cases, and deaths vs. overall population, Bexar Co.

Disparities by sex

  • Across all age groups, females make up 51% of the total Bexar County population, although that percentage increases in older age groups.
  • Females are slightly over-represented in tests (56%) and cases (53%).
  • Males are over-represented among deceased cases or deaths (56%), which is striking given that males are younger as a group (see next charts).

Main points:

  • Compared to the general population, tests and cases are more likely to be female, but deaths are more likely to be male.
  • It’s important to remember that both a COVID-19 case and a COVID-19 death require a COVID-19 test, and testing coverage to date has been wildly uneven across sexes, age groups, race/ethnicities, and occupations.
Age distribution of female Covid-19 cases and deaths vs. overall population, Bexar Co.
Age distribution of male Covid-19 cases and deaths vs. overall population, Bexar Co.

Disparities by sex and age group

The female population of Bexar County is 27% aged 0-19, 29% aged 20-39, 24% aged 40-59, 16% aged 60-79, and 4% aged 80 and older.

  • Cases
    • Only 15% of female cases are aged 0-19, compared to 27% of the female population.
    • Forty percent of female cases are in the 20-39 age group, which makes up only 29% of the female population.
  • Deaths
    • Female deaths skew much older than either female cases or the female population. The 80 and older age group makes up 32% of female deaths, compared to just 3% of cases and 4% of the female population.
    • Among females, those 60 and older make up 20% of the population, 16% of cases, and a staggering 78% of deaths.

 

The male population of Bexar County is younger than the female population, with 29% aged 0-19, 32% aged 20-39, 24% aged 40-59, 13% aged 60-79, and 2% aged 80 and older.

  • Cases
    • Only 16% of male cases are aged 0-19, compared to 29% of the male population.
    • Forty percent of male cases are in the 20-39 age group, which makes up only 32% of the male population.
    • These patterns are similar to those seen with female cases.
  • Deaths
    • Male deaths also skew older than male cases or the male population. The 80 and older age group makes up 22% of male deaths, compared to just 2% of cases and 2% of the male population.
    • Among males, those 60 and older make up 15% of the population, 15% of cases, and a staggering 70% of deaths. Unlike females, though, the proportion of deaths age 40-59 very closely matches the overall population.

Main points:

  • For both males and females, deaths are about 11 times as likely as cases or the population to be age 80 or older.
  • Although the demographics of confirmed cases depend a lot on the demographics of who gets tested, about seven in 10 cases for both males and females are in the working-age population, shown as age 20-59 in these charts.
race/ ethnicity distribution of Covid-19 tests, cases, hospitalized cases, and deaths vs. overall population, Bexar Co.

Disparities by race/ethnicity

The population of Bexar County is about 0.2% American Indian or Alaska Native, 3% Asian or Pacific Islander, 7% Black, 61% Hispanic, 27% white, and 2% other race or multiple races. COVID-19 data is not available for the other/multiracial category.

  • Tests
    • Hispanics make up 82% of total tests as compared to 61% of the population.
    • Tests are only about 50% as likely as the total population to be of people who are white (13% vs. 27%) and 60% as likely to be of people who are Black (4% vs. 7%).
  • Cases
    • Hispanics make up 76% of total cases and 70% of hospitalized cases as compared to 61% of the population.
    • Cases are only about 67% as likely as the total population to be white (18% vs. 27%) and 71% as likely to be Black (5% vs. 7%).
    • The proportion of hospitalized cases who are Black is the same as the general population. The proportion of hospitalized cases who are white is somewhat lower than the general population (22% vs. 27%)
  • Deaths
    • At 1% of deaths, Asians and Pacific Islanders are under-represented in comparison to the general population (3%).
    • Blacks make up about the same proportion of deaths (6%) as they do the general population (7%). 
    • Hispanics make up 66% of deaths as compared to 61% of the population.
    • Whites make up the same proportion of deaths (27%) as they do the general population.

Main points:

  • Hispanics are over-represented among total tests, by a factor of 1.3, while whites are dramatically under-represented, by a factor of -2.1. 
  • That gap largely closes, though, for hospitalizations and deaths.
COVID-19 disparities by county, ratio of percent of covid-19 cases to percent of population by race/ethnicity
COVID-19 disparities by county Graph

The charts in this section create a measure of disproportionality or disparity by relating race/ethnicity distribution of cases and deaths to race/ethnicity distribution of the overall population. A ratio of 1.0 means that a race/ethnicity group makes up the same proportion of cases (or deaths) as the overall population. The lower the ratio, the more under-represented the race/ethnicity group is compared to the overall population. The higher the ratio, the more over-represented the race/ethnicity group is compared to the overall population.

Main points:

  • Race/ethnicity data are not collected, maintained, and reported in a standard way across counties and states, which makes comparisons difficult. Small population, case, and death numbers can also complicate the picture, particularly at the county level.
  • The race/ethnicity disparity in cases and deaths is not playing out in the same way across the country or even within Texas – perhaps not surprising given the heterogeneity within any given race/ethnicity group in who gets tested and diagnosed, age distribution, underlying conditions, health care access, income level, education level, and other social determinants of health.
  • Consistently, however, whites are either equally represented or under-represented compared to the overall population, particularly among cases; the gap narrows for deaths.
  • Hispanics are consistently over-represented compared to the overall population, though not as dramatically in Bexar County as in some other counties and states.

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