Racial and Ethnic Disparities

This article by Reitsma et al. adds to the literature on racial and ethnic disparities related to the COVID-19 pandemic. The article analyzes exposure risk, testing, and cases, providing a detailed assessment at the subcounty level in California, a state with substantial county and regional variation. According to the authors, this is the first study of its type focusing on community scale (subcounty) for the entire state.

• California experienced the highest number of COVID-related deaths of any state as of April 2021 and has a large (40 million) and diverse (37.5% white, 39.1% Latinx, 14.4% Asian, 5.3% Black) population, providing important context for studying disparities and inequities.
• The study found that Latinx and Black populations were overrepresented among COVID deaths (with rates over 1.5 times white population), with Latinx populations also overrepresented in cases despite being underrepresented in testing. Disparities in cases and test positivity rates persisted over time and across the state, even as testing increased.
• The study defined households as “high-exposure-risk” if they had one or more essential workers and fewer rooms than inhabitants. The study found that Latinx persons were over 8 times more likely to live in such households compared to white persons.
• The study adds to the understanding of how COVID-19 has disproportionately impacted disadvantaged populations due to economic and social factors, including essential workers status, multigenerational household living arrangements, and housing and health care access. The existence of such inequities should inform public health efforts to provide continuing interventions and resources.

This article by Cai, Yan & Intrator (currently in pre-proof) examines the interaction between nursing home COVID-19 cases and deaths and the racial/ethnic composition of the facilities and their surrounding communities.

• The study used data from the Centers for Medicare and Medicaid Services (CMS) linked with multiple facility- and community-level data sets to assess nursing home with more than 30 occupied beds and reported weekly COVID-19 cases between June and August 2020.
• The study found that the racial/ethnic composition of nursing homes and their communities were both associated with likelihood of cases and deaths. Even when accounting for community infection rate, racial/ethnic composition of the community remained associated with cases and deaths.
• Additionally, composition modified the relationship between facility characteristics such as RN staffing and these outcomes. For example, higher RN staffing was generally associated with lower likelihood of cases, but this relationship was stronger in communities with a higher proportion of racial/ethnic minority persons. The authors conclude that this may indicate that higher RN staffer improved preparedness and infection control, which became especially important in communities more likely to be under-resourced.
• In contrast, higher CNA staffing was associated with higher probability of cases/deaths in communities with lower minority populations, but was not associated with cases/death in communities with higher minority populations. The authors conclude that this may be due to the likelihood that CNAs come from the surrounding community, potentially putting them at higher risk of infection in under-resourced communities due to use of public transportation, higher community infection rates, and reduced capacity for infection control to prevent cross-infection between direct care workers and residents.