Question  Are racial/ethnic population composition and economic inequality associated with coronavirus disease 2019 (COVID-19) incidence and mortality?

Findings  This cross-sectional ecological analysis of cumulative COVID-19 incidence and mortality rates for the first 200 days of the pandemic in 3141 US counties confirmed positive associations of incidence and mortality rates with racial/ethnic composition and with income inequality well as a joint association of incidence and mortality with both structural factors.

Meaning  This study suggests that COVID-19 surveillance systems should take into account county-level income inequality to better understand the social patterning of COVID-19.