A team of researchers – from Yale University, Wayne State University, the University of Michigan Medical School, the Michigan Department of Health and Human Services, and the University of Maryland School of Medicine – have explored how the coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected Black Americans. They examined the implications of race on COVID-19 mortality in the state of Michigan to underscore the nationwide issue.
Though COVID-19 mortality has disproportionately affected Black Americans across the USA, in Michigan “the disparities are even starker,” note the researchers. While Black Americans represent 14.1% of the state’s population, as of November 5, 2020, 35.0% of statewide COVID-19 mortalities have occurred in this group.
“Underlying this disparate burden,” observe the researchers, “are systemic inequities in socio-economic conditions and health by race, which impact infection exposure and survival.”
The study’s findings have been released on the medRxiv* preprint server.
COVID-19 and inequality
The sinews of inequality are always most palpable in times of crisis – not least during public health crises. As the researchers themselves observe: “Throughout history, epidemics have inequitably affected vulnerable populations in our societies, and the COVID-19 pandemic is no exception.”
As many have noted, the overall impact of COVID-19 on global public health and the economy has underscored pre-existing inequities the world over. Not only has the pandemic accentuated stark inequalities between the Global North and Global South, but it has also emphasized, and even exacerbated, pre-existing inequalities within developed nations.
Here, a disproportionate burden has landed once again on deep and age-old intersections that run along racial and socio-economic lines – not least in the USA.
This research joins a chorus of earlier studies that have mounted much empirical data on the notion that Black individuals have borne the brunt of the economic and health-related fallout from the COVID-19 pandemic.
A number of studies published earlier this year have detailed how places like New York City – which has been the global epicenter of COVID-19 for much of 2020 – saw that Black New Yorkers were twice as likely to be hospitalized than their White counterparts. Along with Hispanic New Yorkers, they were also far more likely to experience COVID-19-related morbidity and mortality.
The USA as storm center
Since March 2020, the USA has been the global epicenter of the pandemic. Nationwide, nearly 14 million cases have been confirmed and over 274,000 people have lost their lives. In Michigan, over 370,000 cases and 9,400 deaths have been reported.
Nervous about the compounding economic effects of more stringent non-pharmaceutical interventions (NPIs), the Trump Administration has been hesitant to impose strict regulations - such as mask-wearing or lockdowns - that might mitigate the ongoing crisis.
The researchers evaluated COVID-19 mortalities in Michigan using individual-level death certificates and surveillance data from the Michigan Department of Health and Human Services from March 16 to October 26, 2020.
It was found that among the 6,065 COVID-19-related deaths, Black individuals were 3.6 times more likely to die from COVID-19 than their White counterparts. Moreover, Black individuals under 65 years without comorbidities had a mortality rate 12.6 times higher than their White counterparts.
Adjusting for age, sex, and comorbidities, the researchers also found that Black individuals in all strata were at higher risk of COVID-19 mortality than their White peers.
COVID-19 Mortality rates per 100,000 population among Black and White Michigan residents and Michigan residents overall by ZIP Code Tabulation Area. Mortality rate per 100,000 population ranges from 0 (yellow) to 100+ (purple). The highest mortality rate per 100,000 population is 5263. Dark grey regions indicate ZIP code tabulation areas where no COVID-19 deaths for a particular race occurred and light grey regions indicate ZIP code tabulation areas where no COVID-19 related deaths took place. These mortality rates are based on 6027 COVID-19 deaths among Michigan residents spread across the state between March 16 and October 26, 2020, of whom 5809 individuals are either White or Black. Total includes individuals of all races. The inset map represents the Detroit Metropolitan Area and Flint.
Why is this?
The researchers illustrate that inequities in mortality are driven not by comorbidity burden or older age but by ongoing structural inequalities. The team highlighted two key areas, among others, that account for how disproportions in COVID-19 mortality relate to systemic racial disparities.
The first is a higher occupational risk for many Black Americans. “While 47 to 49% of White individuals report being able to work from home, only 34 to 39% of Black individuals have the same privilege. Furthermore, Black Americans are disproportionately employed in low-wage and high contact essential service industries within which sick leave is often discouraged and uncompensated.”
The second is long-standing healthcare inequities. Black COVID-19 patients were found not to have received medical attention as promptly as their White counterparts, a factor which is known to influence survival. The researchers tie this to three non-exclusive factors that may contribute to this difference: financial barriers that deter care-seeking, test scarcity, and racial bias among healthcare providers.
The team suggest that these inequities further highlight how underlying disparities across races are compounded in times of crises.
The researchers believe egalitarian social and healthcare reforms can work to redress these imbalances.
The effects of COVID19 shown here highlight a need for corrective resource allocation by federal and local governments that would mitigate the toll of public health crises on vulnerable populations. Universal healthcare, living wages for all workers, and paid sick leave will be important first steps in addressing racial inequities in the US.”
Many will be watching how the Biden Administration entreats this contentious and thorny issue as the president-elect assumes office.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.