Date of Award

2025

Document Type

Thesis

Degree Name

MA in Clinical Psychology

Department

Psychology

First Advisor

Elizabeth Brondolo

Second Advisor

William Chaplin

Abstract

Background: The COVID-19 pandemic disproportionately affected racial and ethnic minority populations in the U.S., with disparities in infection rates and population-level mortality. Research on racial/ethnic differences in case fatality rates (i.e., mortality per diagnosed case) has yielded mixed results, with some studies finding higher mortality for racial/ethnic minority patients and others showing no differences. These inconsistencies may stem from context-dependent factors including neighborhood characteristics. One potential neighborhood variable which may affect health is ethnic density—the concentration of a racial/ethnic group within a neighborhood—which has shown protective, detrimental, and neutral effects in prior studies. Ethnic density may influence health outcomes through mechanisms such as social support or health behaviors. Purpose: To examine racial and ethnic disparities in COVID-19 case-fatality rates and the role of neighborhood influences within a single hospital system in Queens, NY, a racially and socioeconomically diverse urban area that was the U.S. epicenter of the pandemic in 2020. Methods: Medical records from 2,865 hospitalized COVID-19 patients (March–December 2020) were analyzed, incorporating demographic (age, gender, BMI, and race/ethnicity), clinical (mortality), and neighborhood-level socioeconomic data (poverty, insurance, education, crowding, ethnic density). Multiple imputation addressed missing data, and logistic regression examined associations between neighborhood characteristics and mortality risk across racial/ethnic groups. Results: Hispanic patients had lower mortality rates than other racial/ethnic groups, but this difference diminished entirely after adjusting for age, gender, and BMI. Demographic factors were associated with mortality and varied across groups. After adjustment for age, gender and BMI, no significant case-fatality disparities were observed among Hispanic, non-Hispanic Black, non-Hispanic White, and Asian patients. Although neighborhood ethnic density was not associated with case fatality overall, higher Black ethnic density was linked to lower mortality odds for non-Hispanic Black patients. In contrast, higher foreign-born population density was associated with increased mortality odds for non-Hispanic Black patients. Conclusion: These findings suggest that Black ethnic density may be protective for non-Hispanic Black patients in certain contexts, whereas foreign-born density may contribute to higher mortality risk. Future research should explore the underlying mechanisms and how neighborhood factors shape health outcomes to inform targeted public health interventions.

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