Racial and Ethnic Health Disparities Related to COVID-19 | Health Disparities | JAMA | JAMA Network
One of the most disturbing aspects of the coronavirus disease 2019 (COVID-19) pandemic in the US is the disproportionate harm that it has caused to historically marginalized groups. Black, Hispanic, and Asian people have substantially higher rates of infection, hospitalization, and death compared with White people.1,2 According to an analysis by the Kaiser Family Foundation and the Epic Health Research Network, based on data from the Epic health record system for 7 million Black patients, 5.1 million Hispanic patients, 1.4 million Asian patients, and 34.1 million White patients, as of July 20, 2020, the hospitalization rates and death rates per 10 000, respectively, were 24.6 and 5.6 for Black patients, 30.4 and 5.6 for Hispanic patients, 15.9 and 4.3 for Asian patients, and 7.4 and 2.3 for White patients.2 American Indian persons living in the US also have been disproportionately affected by COVID-19.1. In the US, racial and ethnic minority status is inextricably associated with lower socioeconomic status. Black, Hispanic, and American Indian persons in the US are more likely to live in crowded conditions, in multigenerational households, and have jobs that cannot be performed remotely, such as transit workers, grocery store clerks, nursing aides, construction workers, and household workers. These groups are more likely to travel on public transportation due to lack of having their own vehicle. Even for persons who can shelter at home, many persons with low incomes live with an essential worker and have a higher likelihood of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.3
Once infected with SARS-CoV-2, persons who have been marginalized are at greater risk for hospitalization because they often have a higher number of chronic medical comorbidities. The prevalence of hypertension, diabetes, and obesity are higher among low-income, minority populations; all 3 of which have been associated with worse outcomes among patients with SARS-CoV-2 infection. In addition, racial and ethnic minority populations have poorer access to health care, which likely results in persons initiating care later in the course of their illness with COVID-19. Through July 21, 2020, 1.6 million Hispanic persons in the US lost access to their health care coverage since the start of the COVID-19 pandemic.4 Immigrants, whether undocumented or legally in the US, are likely to avoid the health care system altogether due to concerns about deportation or that use of publicly supported services would be used as a reason for denying future immigration.
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