COVID-19 in Racial and Ethnic Minority Groups

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The effects of COVID-19 on the health of racial and ethnic minority groups is still emerging; however, current data suggest a disproportionate burden of illness and death among racial and ethnic minority groups. A recent CDC MMWR report included race and ethnicity data from 580 patients hospitalized with lab-confirmed COVID-19 found that 45% of individuals for whom race or ethnicity data was available were white, compared to 59% of individuals in the surrounding community. However, 33% of hospitalized patients were black, compared to 18% in the community, and 8% were Hispanic, compared to 14% in the community. These data suggest an overrepresentation of blacks among hospitalized patients. Among COVID-19 deaths for which race and ethnicity data were available, New York Citypdf iconexternal icon identified death rates among black/African American persons (92.3 deaths per 100,000 population) and Hispanic/Latino persons (74.3) that were substantially higher than that of white (45.2) or Asian (34.5) persons. Studies are underway to confirm these data and understand and potentially reduce the impact of COVID-19 on the health of racial and ethnic minorities.

[backcolor=rgb(235, 245, 246) !important][size=1.125]Where we live, learn, work, and play affects our health

The conditions in which people live, learn, work, and play contribute to their health. These conditions, over time, lead to different levels of health risks, needs, and outcomes among some people in certain racial and ethnic minority groups.

Factors that influence racial and ethnic minority group health

Health differences between racial and ethnic groups are often due to economic and social conditions that are more common among some racial and ethnic minorities than whites. In public health emergencies, these conditions can also isolate people from the resources they need to prepare for and respond to outbreaks.1,13,14

Living conditions

For many people in racial and ethnic minority groups, living conditions may contribute to underlying health conditions and make it difficult to follow steps to prevent getting sick with COVID-19 or to seek treatment if they do get sick.

• Members of racial and ethnic minorities may be more likely to live in densely populated areas because of institutional racism in the form of residential housing segregation. People living in densely populated areas may find it more difficult to practice prevention measures such as social distancing.
  
• Research also suggests that racial residential segregation is a fundamental cause of health disparities. For example, racial residential segregation is linked with a variety of adverse health outcomes and underlying health conditions.[size=0.65em]2, 3, 4, 5 These underlying conditions can also increase the likelihood of severe illness from COVID-19.
• Many members of racial and ethnic minorities live in neighborhoods that are farther from grocery stores and medical facilities, making it more difficult to receive care if sick and stock up on supplies that would allow them to stay home.
• Multi-generational households, which may be more common among some racial and ethnic minority families[size=0.65em]6, may find it difficult to take precautions to protect older family members or isolate those who are sick, if space in the household is limited.
• Racial and ethnic minority groups are over-represented in jails, prisons, and detention centers, which have specific risks due to congregate living, shared food service, and more.
  

Work circumstances

The types of work and policies in the work environments where people in some racial and ethnic groups are overrepresented can also contribute to their risk for getting sick with COVID-19. Examples include:

• Critical workers: The risk of infection may be greater for workers in essential industries who continue to work outside the home despite outbreaks in their communities, including some people who may need to continue working in these jobs because of their economic circumstances.
  
  • Nearly a quarter of employed Hispanic and black or African American workers are employed in service industry jobs compared to 16% of non-Hispanic whites.
  • Hispanic workers account for 17% of total employment but constitute 53% of agricultural workers; black or African Americans make up 12% of all employed workers but account for 30% of licensed practical and licensed vocational nurses.[size=0.65em]7
    
• A lack of paid sick leave: Workers without paid sick leave might be more likely to continue to work even when they are sick for any reason. This can increase workers’ exposure to other workers who may have COVID-19, or, in turn, expose others to them if they themselves have COVID-19. Hispanic workers have lower rates of access to paid leave than white non-Hispanic workers.[size=0.65em]8
  

Underlying health conditions and lower access to care

Existing health disparities, such as poorer underlying health and barriers to getting health care, might make members of many racial and ethnic minority groups especially vulnerable in public health emergencies like outbreaks of COVID-19.

• Not having health insurance: Compared to whites, Hispanics are almost three times as likely to be uninsured, and African Americans are almost twice as likely to be uninsured.[size=0.65em]9 In all age groups, blacks are more likely than whites to report not being able to see a doctor in the past year because of cost.[size=0.65em]10
• Inadequate access is also driven by a long-standing distrust of the health care system, language barriers, and financial implications associated with missing work to receive care.
• Serious underlying medical conditions: Compared to whites, black Americans experience higher death rates and higher prevalence rates of chronic conditions.[size=0.65em]10
• Stigma and systemic inequalities may undermine prevention efforts, increase levels of chronic and toxic stress, and ultimately sustain health and healthcare disparities.