This post is part of our health equity series. Please read our overview post, Why Health Equity Matters in 2022, to learn more about how you can help advance health equity.
COVID-19 simultaneously exacerbated existing health disparities and introduced entirely new ones. The pandemic disproportionately impacted people of color, and due to a combination of persistent health disparities and social determinants of health (SDoH), they are at higher risk for infection, severe illness, and death.
The Kaiser Family Foundation (KFF) found that early in the pandemic “Black people accounted for more cases and deaths relative to their share of the population in 30 of 49 states reporting cases and 34 of 44 states reporting deaths.” Moreover, they found “the COVID-19 related death rate among Black people was over twice as high as the rate for White people.” While this specific gap has narrowed since 2020, the KFF’s recent research reflects persistent health disparities. Age-adjusted data shows that Black, Hispanic, and Native American people are still more than twice as likely to die from COVID-19 compared to White people. Further, Hispanic and Native American people are at almost two times greater risk for infection than White people.
These disparities reflect historic barriers to care, structural racism, and socioeconomic forces that persistently disadvantage minorities. We’ll explore the most important of these barriers below.
Low-income populations and people of color are more likely to be uninsured. The rate of uninsurance for Native American and Hispanic people is nearly three times higher than the rate for white people. This gap is expected to widen; nearly 50% of coverage in 2019 was distributed through employers, and the pandemic sparked waves of business closures and mass-layoffs. Many workers in the service, manufacturing, and retail industries held positions that could not be performed remotely, and survey data reports that approximately 60% of Hispanic households and roughly 50% of Black households lost a job due to the pandemic, compared to just 40% of White households.
Isolation and quarantine are far more difficult for individuals living in shared housing conditions, and a higher percentage of racial and ethnic minorities live in crowded or multi-generational housing. Further, racial and ethnic minorities are more likely to be exposed to COVID-19 through their occupation or method of transportation. The CDC notes that these groups are “disproportionately represented in essential work settings such as healthcare facilities, farms, factories, warehouses, food processing, accommodation and food services, retail services, grocery stores, and public transportation.” These roles frequently require extended periods of close contact with many others, often in heavily trafficked spaces, resulting in increased risk of exposure.
Extensive travel times and lack of testing sites in one’s community delays testing and subsequent care for minorities at a greater rate than for White people. A study of geographic access to testing early in the pandemic found that 20 minutes was the median travel time to a testing site, but that counties with longer travel times had a higher percentage of the population that were from racial and ethnic minority groups and people living in rural areas. Testing availability has greatly improved since the first months of the pandemic, but inability to take off work, less available transportation, and fear of exposure when using public transportation still disproportionately delays testing for minority populations and low-income communities.
The pandemic is also imposing economic pressure on low-income communities and minorities. These populations are more likely to hold jobs that can’t be performed remotely, potentially leading to either unemployment due to pandemic-related shutdowns or increased risk of contracting COVID-19 due to greater exposure. The KFF reports that “larger shares of Black and Hispanic adults report experiencing negative economic impacts [during the pandemic] with about half saying they have had difficulty paying for basic expenses…compared to 31% of White adults.”
Economic pressure contributes to worse health outcomes and greater disparities, elevating stress and potentially leading to increased exposure and vulnerability. Affected individuals may be forced to work while sick, be unable to seek medical care, struggle to purchase medications, have difficulty maintaining insurance coverage, and may struggle to purchase food and meet other essential needs.
Racial minorities also have a disproportionate burden of chronic diseases, including obesity, diabetes, and kidney disease, and these conditions are a risk factor that may lead to more severe cases of COVID-19. These comorbidities contribute to increased hospitalization and death rates from COVID-19, but the pandemic has also impacted the care and management of chronic conditions independent of COVID-19.
With healthcare resources reserved for the pandemic and fear of increasing the spread, a substantial proportion of people deferred care or completely avoided engaging with health services. One study found that “an estimated 41% of U.S. adults had delayed or avoided medical care including urgent or emergency care (12%) and routine care (32%).” The full impact of COVID-19 on chronic conditions will not be clear for years to come, but this significant gap in diagnoses, routine care, and preventive interventions is likely to dramatically widen associated health disparities.
COVID-19 is further disadvantaging children from low-income families and widening academic achievement gaps that will eventually translate to increased risk for worse health outcomes. Education is a major SDoH, and adults with less education report worse general health, more chronic conditions, and more functional limitations than those with higher levels of education. School closures have the greatest negative impact on children that rely on sponsored programs, such as food and nutritional support initiatives, after-school care, and mental health or social services. Moreover, children without internet access and other technology may be completely left behind by the shift to online learning. Much like the pandemic’s yet-uncertain impact on chronic conditions, its ramifications on education-based health disparities are unclear but likely to be substantial.
To combat disparities caused or exacerbated by COVID-19, healthcare organizations (HCOs) must collect and use data that reflects race, ethnicity, and SDoH. Unfortunately, much of the available COVID-19 data at the federal and state levels lacks this information. As the KFF reports, “nearly two years into the pandemic, we still lack comprehensive data to understand disparities in COVID-19 impacts and uptake of the vaccines.” These limitations make accurate estimates more difficult, and even now race and ethnicity data regarding vaccination is missing for nearly 30% of people who have received at least one dose. Similar gaps in demographic data also exist for breakthrough infection potential.
Effective data collection is an essential first step to addressing health disparities associated with COVID-19 and advancing health equity at scale. Without the necessary data, HCOs attempting to address the impact of COVID-19 will be unable to pinpoint health disparities, develop interventions, and precisely target their efforts to the people at the highest risk for preventable, negative outcomes.
Fortunately, community-based organizations are also working to document, track, and address disparities tied to COVID-19. Partnering with these organizations may enable HCOs to more effectively identify and help those with the greatest need. For example, NPR recently highlighted the efforts of the Black Equity Coalition, a Pittsburgh-based team, that identified the need for more rigorous data collection to address health disparities caused by the pandemic.
Members of the coalition understood that minorities in Pittsburgh were being disproportionately affected, but realized that testing efforts were not recording race. At the state and local levels there was no requirement in place to record it. Without data that reflected race, the coalition and Pittsburgh's HCOs, “couldn’t target [their] attention and know who needed the help most.”
Together, the team mapped and analyzed the locations of COVID-19 testing centers. They found that the people most likely to have easy access to testing lived in neighborhoods predominantly populated by White people, were generally employed in white-collar jobs, and had the financial means to weather the pandemic with delivery services and remote work. Moreover, labor statistics revealed that essential workers keeping Pittsburgh afloat were overwhelmingly people of color.
The Coalition started analyzing the existing data and pushing for improved data collection efforts from local HCOs. They used racial poverty data and geographic data for federally qualified health centers to help advise health authorities and prioritize testing in previously overlooked communities. Using county data, they uncovered that Black people were experiencing hospitalization and more severe cases of COVID-19 at much greater rates.
Their work made a difference; Allegheny county records now only omit race in 12% of positive cases. However, 37% of Pennsylvania testing records are still lacking race. Having helped to shine a light on racial disparities, they provided two key recommendations for HCOs trying to advance COVID-19 equity:
On a national scale, efforts to address vaccination disparities have also highlighted the importance of data collection and the potential for organizations to impact disparities through data-driven, coordinated initiatives. For the first few months the vaccines were available to the U.S. adult population, the Black and Hispanic vaccination rates consistently trailed White and Asian vaccination rates by upwards of 10%. These groups faced access barriers to vaccination, such as a lack of local vaccination sites, and historic racism drove vaccine distrust. In particular, the horrific Tuskegee syphilis study contributed to vaccine hesitancy for Black people.
Vaccination rate data collection and subsequent efforts to close the gap have had a notable impact. As of February 2022, the Hispanic vaccination rate has matched the White rate, and the vaccination rate for Black people has made up nearly 8% of the initial deficit—although significant room for improvement remains. Progress thus far was achieved by identifying the gap and targeting specific populations with interventions designed to address their vaccine education and access needs. The New York Times (NYT) reported on a number of effective initiatives led by hospital systems and community groups, including:
One community organizer encapsulated the importance of these targeted interventions in their comment to the NYT. When discussing their rural, largely Black community, they said, “[the] group of people in this given area or this community don’t have the information or access they need to overcome their hesitancy.”
Without accurately identifying low inoculation rates across race and ethnicity and addressing the specific needs of these communities, vaccination disparity would simply persist. Efforts to eliminate it are ongoing, but HCOs and community leaders have demonstrated impact and made substantial progress. Ultimately, tackling this disparity and addressing the full spectrum of COVID-19-related health disparities hinges on effective data collection and data-driven, targeted interventions.
As of February 2022, there have been 75 million reported cases of COVID-19 in the U.S. and nearly 900,000 deaths due to COVID-19. This suffering has disproportionately impacted racial and ethnic minorities and surfaced a plethora of health disparities. However, HCOs can prioritize race and ethnicity data collection, partner with community-based organizations, and develop effective interventions to mitigate and eventually eliminate disparities in their populations.
To this end, AI solutions can help HCOs improve their data collection processes, normalize disparate data, and proactively address disparities with predictive models. With AI, organizations can optimize use of limited care management resources and target interventions with greater efficiency.
For example, In March 2020, Healthfirst, one of New York’s largest not-for-profit health insurers, integrated their member data with ClosedLoop’s COVID-19 Vulnerability Index (C-19 Index), a series of AI/ML models that predict vulnerability to severe complications from COVID-19. The C-19 Index showed that vulnerability to serious illness from COVID-19 was concentrated—5% of Healthfirst’s population experienced 55% of poor outcomes. As a result, Healthfirst was able to more precisely leverage their resources and better safeguard their most vulnerable members.
To date, the C-19 Index has helped organizations evaluate more than 10 million lives to identify individuals at higher risk of developing severe complications during the pandemic. Please click here to learn more about the C-19 Index and how ClosedLoop is helping to fight COVID-19.
This post is part of our health equity series. If you’re interested in learning more about health equity and what can be done to achieve it, please check out our comprehensive overview post, Why Health Equity Matters in 2022, and our other posts on health equity:
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