The article examines the differential impacts of COVID-19 on black communities in the United States. Using data from U.S. counties, the study finds that counties with a higher proportion of black residents (≥13%) had significantly higher rates of COVID-19 cases and deaths compared to counties with fewer black residents (<13%). The analysis controls for various social and environmental factors, including comorbidities, unemployment, and air pollution. Key findings include: 1. **Racial Disparities**: Counties with a higher proportion of black residents had 52% of COVID-19 cases and 58% of COVID-19 deaths. 2. **Social and Environmental Factors**: These counties also had higher prevalence of comorbidities, higher air pollution, and lower rates of health insurance coverage. 3. **Structural Confounding**: The study addresses the possibility of structural confounding by examining the impact of urbanicity and social distancing scores, finding that the risks of COVID-19 diagnoses and deaths were consistent across levels of urbanicity. 4. **Policy Implications**: The findings highlight the need for policy interventions to address structural racism and inequities in healthcare access and coverage, particularly in rural and small metro counties. The article emphasizes the importance of county-level data and ecological analyses to understand and address racial disparities in the COVID-19 pandemic.The article examines the differential impacts of COVID-19 on black communities in the United States. Using data from U.S. counties, the study finds that counties with a higher proportion of black residents (≥13%) had significantly higher rates of COVID-19 cases and deaths compared to counties with fewer black residents (<13%). The analysis controls for various social and environmental factors, including comorbidities, unemployment, and air pollution. Key findings include: 1. **Racial Disparities**: Counties with a higher proportion of black residents had 52% of COVID-19 cases and 58% of COVID-19 deaths. 2. **Social and Environmental Factors**: These counties also had higher prevalence of comorbidities, higher air pollution, and lower rates of health insurance coverage. 3. **Structural Confounding**: The study addresses the possibility of structural confounding by examining the impact of urbanicity and social distancing scores, finding that the risks of COVID-19 diagnoses and deaths were consistent across levels of urbanicity. 4. **Policy Implications**: The findings highlight the need for policy interventions to address structural racism and inequities in healthcare access and coverage, particularly in rural and small metro counties. The article emphasizes the importance of county-level data and ecological analyses to understand and address racial disparities in the COVID-19 pandemic.