Data Show Undocumented Latinx People Face Disproportionate Burden of Long COVID

As the US continues to address the impacts of the COVID-19 pandemic, it is crucial that underserved populations, including undocumented immigrants, are not left out.

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New findings show that undocumented Latinx immigrants, who make up 7% of the US population, face significant challenges in accessing health care due to high rates of uninsurance, limited access to primary care, language barriers, and fears surrounding their immigration status.¹ The study, which was conducted at 9 emergency departments (EDs) in the US between May and December 2023, aimed to understand the impact of long COVID on this community.

Of 844 eligible patients, 818 participated in the study published in JAMA Network Open. Among them, 136 were undocumented Latinx immigrants, 160 were Latinx legal residents and citizens (LRCs), and 522 were non-Latinx LRCs. The study revealed that undocumented Latinx immigrants were more likely to be uninsured and had less access to primary care compared with the other groups. Additionally, they had limited knowledge about long COVID, with only 11.1% understanding the condition.

Comparing Long COVID Symptoms and Accessing Care

The prevalence of long COVID symptoms was notable across all groups. However, undocumented Latinx immigrants were disproportionately affected; 57.1% of undocumented Latinx immigrants reported missing work or school due to the condition. Meanwhile, those rates were lower among non-Latinx LRCs (46.3%) and Latinx LRCs (35.7%). The authors noted the lack of care received for long COVID symptoms was especially concerning, with 60.0% of undocumented Latinx immigrants reporting not receiving care.

The study acknowledged that it focused on undocumented immigrants who identified as Latinx, and therefore, the findings may not apply to other groups. It was also noted that the definition of long COVID is still developing, and the definition accepted by the CDC at the time of writing was used.

“We recommend culturally relevant and translated resources and protocols in the ED to ensure access to diagnosis and follow-up care for long COVID,” the authors stated. “Future investigations prioritizing inclusion of undocumented people are needed to enhance applicability and generalizability of findings.”

Measuring All-Cause Excess Deaths During the Pandemic

Additional research published in JAMA Network Open demonstrated that diverse and minoritized populations faced higher rates of excess mortality during the COVID-19 public health emergency (PHE).²

Findings from the cross-sectional study analyzing excess mortality from March 2020 to May 2023 highlighted significant racial and ethnic disparities. The investigation measured more than 1.38 million all-cause excess deaths across the US population, with disproportionate impacts on non-Hispanic American Indian or Alaska Native and Hispanic populations. The observed-to-expected mortality ratio of 1.15 (95% CI, 1.12-1.18) corresponded to approximately 23 million years of potential life lost (YPLL).

The average age of decedents was 72.7 years, with Hispanic individuals accounting for 8.9% (944,318) of the deaths, non-Hispanic American Indian or Alaska Native individuals making up 0.7% (78,973), and non-Hispanic Black individuals representing 12.9% (1,374,228) of the total deaths.

These groups exhibited the highest observed-to-expected mortality ratios, especially among individuals aged 25 to 64 years. The American Indian or Alaska Native (AI/AN) and Hispanic groups in this age range experienced mortality ratios of 1.45 and 1.40, respectively, well above the expected baseline.

Notably, AI/AN and Hispanic populations exhibited the highest all-cause mortality ratios across all age groups. The observed-to-expected mortality ratio for AI/AN individuals was 1.34 (95% CI, 1.31-1.37), while the ratio for Hispanic individuals was 1.31 (95% CI, 1.27-1.34). These results indicate significantly higher mortality than would have been expected based on prepandemic trends within these populations.

The age-specific disparities in excess mortality were most pronounced in working-age adults. Non-Hispanic Black individuals accounted for just 13.8% of the US population under age 25, and yet they represented 51.1% of excess deaths in this age group during the study period. The study estimates that if the White population's mortality rate had been applied across all racial and ethnic groups, more than 252,000 fewer deaths would have occurred—an 18.3% reduction in excess mortality. Moreover, the YPLL would have been reduced by 5.2 million (22.3%).

“To prepare for future pandemics, efforts to protect high-risk groups—utilizing evidence-based policy, equitable distribution of resources, and improving infrastructure—are essential,” the authors wrote. “To achieve this, systemic factors must be addressed. In addition to preparation, just-in-time responses should be directed toward high-risk communities during emergencies (pandemics, natural, or human-caused disasters).”

References

1. Reyes KP, Rafique Z, Chinnock B, et al. Long COVID among undocumented Latino immigrant populations in the emergency department. JAMA Netw Open. 2024;7(10):e2438806. doi:10.1001/jamanetworkopen.2024.38806

2. Faust JS, Renton B, Bongiovanni T, et al. Racial and ethnic disparities in age-specific all-cause mortality during the COVID-19 pandemic. JAMA Netw Open. 2024;7(10):e2438918. doi:10.1001/jamanetworkopen.2024.38918