US Black Women's Health Before and After the COVID-19 Pandemic: Socioeconomic and Temporal Patterns

Objectives. To examine how socioeconomic status (SES) shaped intraracial health disparities among Black women before, during, and after the COVID-19 pandemic. Methods. Using Behavioral Risk Factor Surveillance System data (2018-2023; n = 89 634 Black women), we analyzed temporal trends in self-rated health, days of poor physical and mental health, and SES (education, income, employment). Results. Educational disparities in self-rated health temporarily compressed during the pandemic (health disparity decreased by 3.9%) before partially reexpanding after the pandemic. Income-based physical health disparities persisted: the lowest-income women reported 7.48 poor physical health days before the pandemic versus 2.38 days for highest-income peers. Mental health decreased universally, with lowest-income women reporting 7.00 poor mental health days per year after the pandemic versus 6.09 days before the pandemic. Unemployed women experienced temporary pandemic-period health improvements (b = -2.07; P = .05) Conclusions. Although the pandemic temporarily compressed educational disparities, income and employment-based inequities persisted or widened, underscoring SES as a partial buffer and site of structural health inequality. Public Health Implications. Sustaining pandemic-era protections (expanded health care, income supports) and prioritizing mental health equity are critical to addressing systemic inequities exacerbated by crises. (Am J Public Health. 2026;116(4):502-511. https://doi.org/10.2105/AJPH.2025.308348).