Racial, Ethnic Disparities Evident in COVID-19 Data

New data suggest members of ethnic minorities face a higher risk of hospitalization, intensive care unit (ICU) admission, and in-hospital death from COVID-19 compared with White Americans.

The report, published in JAMA Network Open, offers a better understanding of the ways in which pre-existing healthcare disparities impacted outcomes during the first year of the pandemic.

Corresponding author Shikha Garg, MD, MPH, of the Centers for Disease Control and Prevention, and colleagues, explained that data in the early weeks showed disparities between racial and ethnic groups in terms of hospitalization rates. However, such data were preliminary and limited in scope. In hopes of better understanding pandemic experiences across a longer time horizon, Garg and colleagues consulted the COVID-19 Associated Hospitalization Surveillance Network, culling data from 14 participating states and 99 counties within those states. The database yielded 153,692 patients who were hospitalized for COVID-19. The majority of patients were over the age of 50. Racial and ethnic information were available for 143,342 of those patients.

The data showed that, after adjusting for age, non-Hispanic American Indians, Alaska Natives, Latinos, Blacks, and Asian or Pacific Islanders were more likely to be hospitalized, be admitted to the ICU, or die in the hospital from COVID-19, compared to white patients.

Garg told Contagion that while the findings aligned with earlier research highlighting gaps in patient outcomes, some of the age-based variance in the data was particularly surprising. For instance, among children under the age of 18, Hispanic and Latino children had the highest rates of hospitalization. Among adults 18-64, American Indian and Alaska Native people had the highest hospitalization rates. Among those age 65 and older, American Indian, non-Hispanic Black and Hispanic or Latino people had the highest hospitalization rates.

“In addition, after adjusting for age, rates of ICU admission and death were highest for American Indian or Alaska Native persons, with ICU rates 6.5 times higher and death rates 7 times higher than those of non-Hispanic White persons,” Garg said.

Garg said it is not possible to determine from these data why or how the mass public-health programs associated with the government’s pandemic response were unable to eliminate such disparities, though the report notes that health disparities among racial and ethnic groups were a problem long before the pandemic, in part due to a lack of access to care in some areas. Garg said the CDC continues to work with local public health agencies to boost outreach to minority communities and to track outcomes.

Going forward, Garg said physicians can help to combat the problem by, first and foremost, encouraging patients to get vaccinated against SARS-CoV-2, noting that studies suggest medical mistrust is a major factor in vaccine refusal.

“Clinicians can help build trust in COVID-19 vaccines among their patients by having empathetic vaccine conversations, addressing myths and common questions, and providing tailored vaccine information to patients,” Garg said.

Garg added that the study data show underlying medical conditions played a major role in hospitalizations among patients with COVID-19.

“Clinicians should continue to emphasize the need for preventative care among their patients and promote management and control of chronic underlying health conditions which can increase the risk for severe COVID-19,” Garg added.