Social Inequities Clarify Racial Gaps in Pandemic, Research Discover

When Dr. Gbenga Ogedegbe began researching coronavirus infections in black and Hispanic patients, believed he knew what to find. Infected black and Hispanic patients would be hospitalized and dying more often compared to white patients.

But that’s not how it turned out.

Dr. Ogedegbe, the director of the Department of Health and Behavior at New York University’s Grossman School of Medicine, and colleagues reviewed the medical records of 11,547 patients in NYU’s Langone Health system between March 1 and April 8 have been tested for coronavirus infections.

After considering various differences, Dr. Ogedegbe found that infected black and Hispanic patients were no more hospitalized than white patients. Black patients had a slightly lower risk of death in the hospital.

“We were surprised,” said Dr. Ogedegbe.

The study was published in the journal JAMA Network Open. Three other recent large studies have come to similarly surprising results.

The new findings don’t contradict a massive body of research showing that black and Hispanic Americans are more likely to be affected by the pandemic compared to whites. Coronavirus is more prevalent in minority communities, and infections, diseases and deaths have emerged in disproportionate numbers in these groups.

However, the new studies suggest that there is no innate susceptibility to the virus in Black and Hispanic Americans, said Dr. Ogedegbe and other experts. Instead, these groups are more exposed due to social and ecological factors.

“We hear this all the time – ‘Blacks are more susceptible,'” said Dr. Ogedegbe. “It’s all about the exposure. It’s about where people live. It has nothing to do with genes. “

Black and Hispanic communities and households tend to be overcrowded, along with many other security vulnerabilities. Many people work in jobs that require frequent contact with others and rely on public transport. Access to health care is poorer than that of white Americans, and the basic conditions are much higher.

“To me, these results make it clear that the differences in mortality we see are even more appalling,” said Jon Zelner, an epidemiologist at the University of Michigan who led one of the new studies.

The toll on Black and Hispanic Americans “could easily have been alleviated before the pandemic through a less worn and gruesome approach to social welfare and health care in the US,” he added. “Even if it hadn’t worked, so much of it could have been avoided.”

For example, the federal government could have protected citizens from risky work situations by providing income subsidies that allowed them to stay at home, said Dr. Zelner. The government could have provided workers in nursing homes and long-term care facilities with adequate protective equipment.

Dr. From March to June, Zelner and his colleagues examined data on 49,701 coronavirus patients in Michigan who were and were not hospitalized. In this population, the death rate in black and white patients was the same: 11 percent.

(The high rate reflects the fact that Michigan incidence was dominated by the elderly at the beginning of the epidemic, Dr. Zelner said. The data pertains to detected cases rather than all infections during that period, when it was much less Tests gave.)

A study of patients in Veterans Affairs hospitals led by Dr. Christopher Rentsch of the London School of Hygiene and Tropical Medicine and VA researchers analyzed the health records of more than five million patients in more than 1,200 facilities.

About 16,317 tested positive for the coronavirus. Dr. Rentsch found that among them there was no difference in the death rate between white, black, or Hispanic patients.

The researchers had expected that underlying health conditions would result in higher death rates in Black and Hispanic patients, who are more likely to suffer from obesity and high blood pressure, which increase their risk for severe Covid-19.

However, when analyzing the death rate, these conditions “hardly moved,” said Dr. Rentsch. However, overall health differences between VA patients by race tend to be smaller than that of Americans, he warned.

A New Orleans study led by Dr. Eboni Price-Haywood, director of the Ochsner Center for Outcomes and Health Services Research, included the 3,481 patients who tested positive for the coronavirus between March 1 and April 11.

She and her colleagues found that black and white patients had the same death rate.

“It’s always confusing when people read the paper,” said Dr. Price-Haywood in an interview. But, she added, when someone was sick enough to be hospitalized, race became irrelevant.

“If you were fragile enough to be admitted, you were fragile enough to die,” said Dr. Price-Haywood.

The four studies confirmed large differences in the incidence of coronavirus infections between minority and white patients.

In the study by Dr. Ogedegbe, black and Hispanic patients were 60 to 70 percent more likely than whites to get infected. In research in Michigan, the incidence of infection in blacks was four times higher than that of whites.

“If you were to replace the white incidence rates with the black, it would reduce mortality by 83 percent,” said Dr. Zelner.

In the VA study, nine out of 1,000 white veterans had a positive coronavirus test, compared with 16.4 out of 1,000 for black patients. In New Orleans, black patients made up 76.9 percent of patients hospitalized with Covid-19, even though they made up only 31 percent of the healthcare system population.

These differences are fully explained by socioeconomic factors, researchers said.

“The bigger problem is the role of social determinants of health,” said Dr. Price-Haywood. “Race is a social construct, not a biological one.”

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