Socioeconomic Status and Racial Disparities

Socioeconomic status has played a major role with SARS-CoV-2.  Those who have a low socioeconomic status have high incidence rates of SARS-CoV-2 as well as high case-fatality rates.  This study examined the association between socioeconomic status, increases in SARS-CoV-2 cases, and related mortality.  The sample included 2664 counties in the U.S.  The main explanatory variable was the social deprivation index (SDI) which is a county-level measure of seven socioeconomic characteristics:  percent of adults without a high school degree, percent of households with a single parent, percent living in overcrowded housing, percent living in rental units, percent of households without a car, the unemployment rate, and the poverty rate. The measure ranges from 1-100; the higher the value, the greater the deprivation.  Adjusted differences were estimated using linear regression with state-fixed effects.  The results indicated that high SDI levels were seen in counties that were larger and more densely populated.  These counties also had higher percentages of African American and Hispanic residents.  The adjusted difference in SARS-CoV-2 cases per 1000 persons reported in May 2020 between high- and low-SDI counties was 2.56 (95% CI, 1.77 to 3.34; P<.001), and the difference in deaths per 100,000 was 5.09 (95% CI, 3.25 to 6.94; P<.001). The adjusted difference in SARS-CoV-2 cases per 1000 persons between medium- and low-SDI counties was 1.39 (95% CI, 0.85 to 1.93; P<.001), and the difference in deaths per 100,000 was 1.63 (95% CI, 0.20to 3.06; P=.03).  High SDI level was also associated with more SARS-CoV-2 cases and related deaths.

This commentary further elaborates on how COVID-19 disproportionately affects certain racial groups.  Specifically, it states that African Americans, American Indians, and Latinos were at an increased risk for severe illness and death from COVID-19 than were non-Hispanic Whites, and these same people were (and are) more likely to contract the virus largely because they hold jobs that they are unable to leave and must travel to.  It also states that two elements, structural segregation and inequality, have positioned African Americans and other people of color to be at an increased risk of contracting severe COVID-19.  Additional factors such as continual environmental and employment exposures place African American and other people of color at increased risk. In New York City, however, the five zip codes with the highest COVID-19 rates showed a significant overrepresentation of Latinos (45.8%) and Asians (23.4%), and a significant underrepresentation of non-Hispanic Whites (21.2%) and African-Americans (8%) when compared with their citywide populations.  The age-adjusted death rate for COVID-19 was 22.8 per 100,000 people among Latinos in New York. This is higher than the rate among African Americans (19.8), non-Hispanic Whites (10.2), and Asian Americans (8.4).  The commentary concludes by stating that COVID-19 is most dangerous for the less able and those with meager incomes which includes African Americans and other racial groups and changes must be made to reduce the highly prevalent health inequalities.

Similarly, this article discusses the disparities seen in mortality rates related to COVID-19.  African Americans have bore much of the burden and the article states that two elements are may explain this:  implicit bias and structural racism.  The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and are difficult to consciously acknowledge and control. These attitudes often times are activated and can influence human behavior without conscious volition.  Therefore, implicit bias among health care professionals may lead to disparities in how health care is delivered. Most health care providers appear to have implicit bias in terms of positive attitudes toward Whites and negative attitudes toward people of color. The article concludes by stating that health care professionals often fail to acknowledge the effect of implicit bias in their own practices. In order to reduce health disparities, health care organizations must identify strategies to address implicit bias and structural racism.