Disparity in COVID-19 Related Death & Disease

While the influence of social determinants on the health of minority populations is well documented, the COVID-19 pandemic represents a new challenge to the health of Americans and is affecting minority populations disproportionately. As of May 9, 2020, for instance, deaths among African Americans due to COVID-19 accounted for almost double their population share.

Speculation as to why African Americans were bearing a burden of mortality twice their representation in the US population was initially tied to the pre-existing chronic health conditions that already affect African Americans at disproportionate rates including

• Hypertension
• Diabetes
• Asthma
• Cerebrovascular disease
• Acquired Immune Deficiency Syndrome (AIDS)

A recent analysis, however, shows counties that are predominantly African American are currently bearing higher burden of both COVID-19 diagnoses and COVID-19 related deaths even after controlling for chronic conditions such as heart disease, hypertension, diabetes, and HIV, suggesting that social factors again may be elevating the degree of disease burden borne by predominantly black communities. In fact the same analysis shows that counties with higher unemployment were relatively protected against COVID-19 as evidenced by lower rates of diagnoses, as were counties with greater access to healthcare, and counties with fewer individuals per dwelling.

These findings could mean that individuals or segments of the population who are unable to perform job duties from home (ie, frontline workers, essential workers) or who cannot afford a temporary leave from employment were and continue to be placed at higher risk of infection. With African Americans making up a larger proportion of our Nation’s essential worker professionals it makes sense that African American individuals would acquire COVID-19 at higher rates (given continuous exposure to the public). Professions where African Americans, specifically, are over-represented and likely encountered excess risk of infection include:

• Public Transportation
• Community food and housing programs
• Security services
• Warehousing
• Food processing and Packaging
• Child Care Services

Individuals working in these professions would have had regular contact with other individuals throughout local lockdown periods and may not have had ready access to personal protective equipment (PPE) at early stages of the pandemic when masks were redirected toward the nation’s hospitals and health care facilities. However, without more data including the occupation and ethnicity of those whose death can be attributed to COVID-19, this remains conjecture.

Center Director Vickie Mays is currently working with members of congress on a bill to require better data on the race and ethnicity of people affected by the COVID-19 pandemic so that the BRITE Center and other public health organizations can better address and respond to the differential impact COVID-19 is having on minority communities.

Related Links

• Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: evidence and interventions. Lancet, 389(10077), 1453–1463.
• Carter-Pokras O. D., Offutt-Powell T. N., Kaufman J. S., Giles W. H., Mays V. M. (2012). Epidemiology, Policy, and Racial/Ethnic Minority Health Disparities. Annals of Epidemiology, 22(6),446-55.
• Department of Labor Statistics. (2020). Labor Force Statistics from the Current Population Survey. https://www.bls.gov/cps/cpsaat18.htm
• Foxman, B., Camargo, C. A., Lilienfeld, D., Linet, M., Mays, V. M., McKeown, R., Ness, R., & Rothenberg, R. (2006). Looking back at hurricane Katrina: Lessons for 2006 and beyond. Annals of Epidemiology, 16(8), 652-653.
• Millett, G. A., Jones, A. T., Benkeser, D., Baral, S., Mercer, L., Beyrer, C., Honermann, B., Lankiewicz, E., Mena, L., Crowley, J. S., Sherwood, J., & Sullivan, P. S. (2020). Assessing differential impacts of COVID-19 on black communities. Annals of Epidemiology, 47, 37–44.
• Thorpe, L. E., Assari, S., Deppen, S., Glied, S., Lurie, N., Mauer, M. P., Mays, V. M., & Trapido, E. (2015). The role of epidemiology in disaster response policy development. Annals of Epidemiology, 25(5), 377-386.