A new study of California coronavirus patients adds to a burgeoning body of evidence that the virus disproportionately impacts racial and ethnic minorities.
African-American COVID-19 patients have 2.7 times the odds of being admitted to the hospital compared to non-Hispanic white patients after controlling for sex, age, income and co-morbid health conditions, according to a study in the journal Health Affairs conducted by researchers affiliated with Sutter Health, a nonprofit health system in northern California.
The researchers, who analyzed 1,052 confirmed coronavirus cases between Jan. 1 and April 8, said there could be a number of potential explanations for this gap, including that African-American patients might have “more advanced or severe illness at the time of presenting for COVID-19 testing and medical care.”
“One hypothesis is that there may be some unknown or unmeasured genetic or biological factors that increase the severity of this illness for African Americans,” they wrote. “Another possibility is that our results are explained by societal factors that either result in barriers to timely access to care, or create circumstances in which patients view delaying care as the most sensible option.”
“ ‘Our findings suggest that the greatest risk, in terms of hospitalization, is borne by the African American community. This pandemic offers the opportunity to identify and quantify these inequities, and to seek solutions.’ ”
Health-care providers’ unconscious biases and patients’ negative health-care experiences in the past could also result in a lack of trust and “the decision to seek care only in the most extreme circumstances,” they wrote.
“This has been documented in health-care settings across the U.S. and remains a major threat to health equity,” the authors wrote. “Presentation and testing in the [emergency department] and hospital may indicate that African Americans seek care at a later stage, leading to the higher rates of admissions.”
Several previous studies have suggested that black and Hispanic Americans bear a disproportionate share of COVID-19 illness and death. President Trump said last month that black Americans were “getting hit very, very hard” by the disease.
“This is a real problem and it is showing up very strongly in our data on the African-American community,” he said during a coronavirus briefing.
An Associated Press analysis last month of COVID-19 cases and deaths across the country found that among victims whose demographic data was available, 42% were black — while black people made up just 21% of the analyzed areas’ total population. The report noted that historic inequities in health-care access and economic conditions, as well as institutional racism, had increased black Americans’ susceptibility to the coronavirus.
Racial and ethnic minorities are also overrepresented in essential jobs that require them to commute to work outside the home, the Centers for Disease Control and Prevention pointed out. They are more likely to have underlying health conditions that might make them more vulnerable to severe cases of the disease, and less likely to have health insurance.
“The experience of Sutter Health highlights the fact that race and ethnicity play a pivotal role in determining how and when care is accessed, and the outcome,” the Health Affairs article said. “Our findings suggest that the greatest risk, in terms of hospitalization, is borne by the African American community. This pandemic offers the opportunity to identify and quantify these inequities, and to seek solutions.”