Behind the Numbers: COVID-19, Race and Equity

Evidence-Based Medicine

Medicine encompasses a wonderful realm of healing; however, what if that opportunity for healing was not equal for all? This is what we have witnessed in 2020 with the COVID-19 virus. What has been prevailing throughout history is now being even further unveiled and highlighted through one of history’s largest pandemics.

COVID-19: Disproportionate Outcome on Latinos and Blacks

The US Census Bureau recently showed that during the pandemic, 41% of adults experienced symptoms associated with depressive and anxiety... At the highest rate of mental health concerns were Latinx and Black people in addition to women and low-income individuals.

In a two-month study from late April to late June 2020 [1], there were 48,788 cumulative Covid-19 cases in the states of Arizona, Indiana, Kansa, Massachusetts, Minnesota, New Hampshire, Ohio, Oregon, Rhode Island, Utah, Virginia and Washington. Researchers found that the percentage of Black-patient hospitalization exceeded that of the Black proportion within the state population. Specifically, in Ohio, Black patients accounted for 31.8% of the hospitalizations, while comprising 13% of the population.

Furthermore, out of 11 states which had reported COVID-19 hospitalizations for Hispanic patients, 10 of those states had hospitalization for Hispanic patients higher than their respective proportion for that state. For example, in Virginia, despite the Hispanic community comprising 9.6% of the state's population, Hispanic patients accounted for 36.2% of COVID-19 hospitalizations.

During these challenging times, people have also been struggling with day-to-day challenges, which is having a significant impact on their health. According to the Commonwealth Fund [2], Latino and Black people are experiencing higher rates of economic hardship than their white counterparts. Such disproportionate outcomes are illustrated below:

Charts are used with permission from the Commonwealth Fund.

Similar disproportionate trends were flagged in mental health as well. The US Census Bureau recently showed that during the pandemic, 41% of adults experienced symptoms associated with depressive and anxiety disorders[3]. At the highest rate of mental health concerns were Latinx and Black people in addition to women and low-income individuals.

Charts are used with permission from the Commonwealth Fund.

Fueling Factors that Increase the Risk of COVID-19

According to the Center for Disease Control, four social determinants of health contribute to a higher risk of COVID-19 exposure and death for certain minority groups[4]:

Healthcare access and utilization: Individuals from certain minority groups are more likely to have limited access to healthcare resources. Disparity examples include differences in medical insurance, access to transportation, ability to take time off work, language barriers, cultural differences, and both the historical and current inherent discrimination in the healthcare system.

Occupation: African Americans, American Indians and Latinos are disproportionately represented in essential work settings such as factories, healthcare facilities, grocery stores and public transportation. These individuals have a higher chance of virus exposure because they cannot work remotely, are in close contact with the public and do not have paid sick days.

Education: Disparities in access to quality education result in some ethnic and racial minority groups facing lower high school completion rates and barriers to obtaining higher education. This then results in limitations to job options, lower paying jobs and less stable occupations. Less flexible jobs and options then put these individuals in a tight situation of not being able to afford missing work.

Housing: Some individuals are unable to follow certain prevention strategies due to the crowded conditions of their living space. Furthermore, with the increasing and disproportionate rate of unemployment for some minority groups during the pandemic, this may result in increased sharing of housing, eviction or homelessness

A Light at the End of the Tunnel

With all these statistics comes a room for hope, an opportunity for intervention. Due to the overwhelming presence of these disproportionate cases of SARS-CoV-2 belonging to groups such as Native American, Latinx and African Americans, the National Institute of Health has created the following statewide alliance: Community Engagement Alliance Against COVID-19, also known as CEAL. With the support of the NIH, the University of Arizona will be using this 12 million dollar award for purposes of outreach and engagement across 11 states: Alabama, Arizona, California, Florida, Georgia, Louisiana, Michigan, Mississippi, North Carolina, Tennessee and Texas[5]. The initiative encompasses establishing connections between NIH-funded researchers and local community leaders to reach communities that may not be in close proximity to COVID-19 clinical sites. If you would like to learn about the way Covid impact varies by race, visit https://covidtracking.com/race.

References

01. Karaca-Mandic P, Georgiou A, Sen S. Assessment of COVID-19 Hospitalizations by Race/Ethnicity in 12 States [published online ahead of print, 2020 Aug 17]. JAMA Intern Med. 2020;e203857. doi:10.1001/jamainternmed.2020.3857

02. Getachew Y, Zephyrin L, Abrams MK, et al. Beyond the Case Count: The Wide-Ranging Disparities of COVID-19 in the United States. Commonwealth Fund website. Published September 10, 2020. Accessed November 16, 2020. https://doi.org/10.26099/gjcn-1z31

03. United States Census Bureau. Week 12 Household Pulse Survey: July 16–July 21. United States Census Bureau website. Last Revised July 28, 2020. Accessed November 16, 2020. https://www.census.gov/data/tables/2020/demo/hhp/hhp12.html

04. Centers for Disease Control and Prevention. Health Equity Considerations and Racial and Ethnic Minority Groups. Centers for Disease Control and Prevention website. Updated July 24, 2020. Accessed November 16, 2020. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html

05. University of Arizona Health Sciences. UArizona Health Sciences to Lead Statewide Outreach to Reduce Disparities in COVID-19 Research, Clinical Studies. University of Arizona Health Sciences website. Published October 29, 2020. Accessed November 16, 2020. https://uahs.arizona.edu/news/uarizona-health-sciences-lead-statewide-outreach-reduce-disparities-covid-19-research-clinical

Author

Bahareh Sharafi is a second year medical student at Ross University School of Medicine.