UCSF

"Sundown towns" across the US prevented racial and ethnic minorities from living and working within their borders as they forced minorities to leave these towns after sunset. The objective of this study was to explore the relationship between historic sundown town status, COVID-19 local risk index and racial/ethnic city-level diversity. We used a multi-level hierarchical model was used to examine the effect of historic sundown town status on the COVID-19 local risk index and city-level diversity. Over 2,400 Sundown towns were cataloged across the United States, with the greatest density in the Midwest. Sundown towns, which historically excluded racial/ethnic minorities, had significantly less racial/ethnic diversity as measured and lower COVID-19 local risk index compared to non-Sundown towns. Findings show that residual segregation enforced by historic Sundown towns continues to impact current inequities among racial/ethnic minorities related to risk for COVID-19 at the neighborhood level. We recommend that public health officials for pandemic preparedness should devote greater resources to these historically segregated racial/ethnic minority areas because of the higher risk these areas possess because of structural racism brought on my historical segregation policies.