COVID-19 and Health Disparities: Preexisting Factors Impact Exposure, Recovery

Eleven months after the first reported case of coronavirus disease 2019 (COVID-19), new data continue to document the crisis’ physical, mental, and economic toll on the nation’s most vulnerable populations.

Disparities in health care existed long before ‘COVID-19’ entered the American vernacular, but no event in modern history has shined such an intense light on the myriad of imminent health challenges facing these populations.

And, those disparities have an impact on nearly every aspect of the crisis: from health outcomes, to access to resources and care, to exposure through employment, to how information is received, and, crucially, may influence the reception of a vaccine for SARS-CoV2, which causes COVID-19.

While doses of the vaccine are not expected to become available to the general public until sometime in 2021, on December 1, the Advisory Committee on Immunization Practices recommended that the nation’s 21 million health care workers and 3 million residents of nursing homes and other long-term care facilities be first to receive them.

An FDA advisory panel is slated to hear Pfizer’s application for its vaccine candidate this Thursday, December 10, followed by Moderna on December 17.

With leading health experts warning of a grim few months ahead as the pandemic continues to rage, and as a vaccine launch draws nearer, this 3-part series explores the impact of existing health disparities on COVID-19 and some potential solutions.

Factors Contributing to Disparities

In the spring of 2020, insights into which pre-existing conditions bring greater risk of COVID-19 complications were beginning to be established. Individuals with diabetes, compromised immune systems, or other chronic conditions were initially cited as being at a higher risk of more severe outcomes. In the months since, the list has grown to include obesity, chronic kidney disease, chronic obstructive pulmonary disease (COPD), serious heart conditions, and sickle cell disease, according to the CDC.

In the United States, people of color have higher rates of chronic diseases than their White counterparts —a factor which contributes to the disproportionate COVID-19 mortality rate seen in these populations. For example, the risk of being diagnosed with diabetes is 77% higher for African Americans and 66% higher among Hispanics compared with White Americans

An analysis of data from over 110,000 COVID-19-associated deaths reported to the National Vital Statistics System in the summer of 2020 found around a quarter of decedents (24.2%) were Hispanic or Latino while 18.7% were non-Hispanic Black. Between May and August 2020, the percentage of distribution of Hispanic decedents increased from 16.3% to 26.4%.

Additional data from 5.8 million people who tested positive for COVID-19 between March and mid-October showed Black Americans were 37% more likely to die than White Americans after controlling for age, sex, and mortality rates over time, The Washington Post reports. The same data also showed Asian Americans were 53% more likely to die, Native Americans and Alaskan Natives were 26% more likely to die and Hispanics were 16% more likely to die.

From an economic standpoint, low-income individuals are more likely to have chronic illnesses, while individuals with low incomes in America are disproportionately racial and ethnic minorities. As of 2019, Hispanic or Latino individuals made up the largest minority population in America (18.5%), followed by Black or African Americans (13.4%), and Asian Americans (5.9%), according to the US Census. White Americans make up the majority, at around 76%.

As ProPublica reported early on in the pandemic, “African Americans have gravitated to jobs in sectors viewed as reliable paths to the middle class—health care, transportation, government, food supply — which are now deemed ‘essential,’ rendering them unable to stay home.”

Compounding heightened risks of exposure, lack of insurance coverage and subsequent cost concerns could stop individuals from seeking medical care for COVID-19. In April, a Gallup poll found 1 in 7 Americans (14%) reported they would avoid seeking health care for a fever and dry cough—common COVID-19 symptoms—for themselves or a family member due to cost concerns. Totaled, this percentage amounts to millions of Americans. The groups most likely to avoid seeking care due to cost were adults under 30 years old, racial minorities, individuals with a high school education or less, and those residing in households with incomes under $40,000 per year.

A report published by Avalere Health concluded at least 5 million Black and Hispanic individuals may ultimately lose their health insurance in 2020 as a result of the pandemic. The percentage loss of health insurance coverage among this population, including losses incurred by Asian populations, is approximately double that of White individuals.

Prior to the pandemic, Black and Hispanic individuals were more often covered by Medicaid or lacked insurance altogether compared with White individuals. “While a greater number of White people lost their employer coverage from February to April 2020, Black and Hispanic people faced a disproportionately larger loss of coverage relative to their populations,” the report found.

Meanwhile, analyses conducted in July found states reporting spikes in COVID-19 cases were also reporting the highest rates of health insurance losses. But states that expanded Medicaid under the Affordable Care Act (ACA) tended to report lower uninsured rates.

Taken together, the data prompt questions as to what the future of health care will look like in America, with particular emphasis on closing the racial, economic, and geographical gaps.

Next:

• How leaders are trying to combat misinformation and rebuild trust as a vaccine nears.
• How a public-private partnership enabled outreach to Maryland's most vulnerable populations.