Decreasing comorbidities among BIPOC groups could lessen hospitalization disparities
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Key takeaways:
- Hospitalization and mortality rates are overall disproportionate among BIPOC populations.
- Increasing vaccination and decreasing comorbidities among BIPOC populations may decrease race-based hospitalization disparities.
Decreasing comorbidities and increasing vaccination rates among Black, indigenous and other people of color could help balance out symptomatic infection rates, according to a modeling study assessing interventions in these communities.
“During the COVID-19 pandemic, the hospitalization and mortality rates were terribly unequitable, with [Black, indigenous, and other people of color (BIPOC)] communities populations carrying a disproportionate burden of disease,” Laura Matrajt, PhD, associate professor in the University of Washington’s Department of Applied Mathematics, told Healio.
“In 2022, we did a retrospective analysis of COVID-19 vaccination campaign in 2021. The idea was to study if a more equitable distribution was possible. This prompted our interest to look at other infectious diseases and the distribution of hospitalization and mortality rates among different populations,” she said.
To do so, Matrajt and colleagues created a race-stratified agent-based model of seasonal influenza transmission. Matrajt said that the team chose influenza because it would provide a good basis in the event there is an avian influenza pandemic in the future and because there is readily available race-stratified data on the number of hospitalizations in the U.S.
Using these available data, they quantified the effects of five interventions meant to reduce inequities in symptomatic infections and hospitalizations:
An “equal vaccination” scenario for which the age-stratified vaccination rates were equalized for all race groups;
An “equal comorbidities” scenario for which the age-stratified risks of disease progression based on infection were equalized for all race groups;
An “equal work-risk” scenario for which the race distribution of workers was proportional to that of the population regardless of workplace size;
A “low-risk workplaces” scenario for which all workplaces are assumed to have less contacts;
And an “equal disease progression and low-risk workplaces” scenario where the probabilities of vaccinations and severe outcomes are equalized and workplaces are low risk.
Overall, the study showed that “relatively small” interventions such as increasing vaccination rates in some populations and reducing work exposures could reduce the inequities observed in influenza hospitalizations.
“By ‘relative,’ I mean that although these interventions are difficult and expensive, it is relatively easier and cheaper to do and cheaper to do interventions like increasing vaccination rates than to make systemic changes in the society,” Matrajt said.
Specific data from the study showed that increased vaccination rates among younger adults aged 18 to 49 years in Black, American Indian or Alaska Native, and Hispanic communities showed the most benefit with up to 17% less symptomatic infections compared with the baseline scenario.
The authors wrote that this is particularly important because these populations tend to have less access to medical care, work benefits such as working remotely or having paid sick leave, and more likely to work in “frontline occupations.”
They added that corresponding white counterparts in the study also experienced lower rates of symptomatic infections — up to 15%. However, the researchers wrote that this was “most likely due to indirect protection resulting from reduction in overall transmission.”
The study also demonstrated that different racial-ethnic groups responded differently to the interventions, Matrajt said. For example, the study showed that although hospitalization rates were decreased in young adults in the Hispanic and Alaska Native/American Indians with interventions that reduced work exposure or increased vaccination, these same interventions did not have the same impact in the Black young adults.
If Black adults aged 18 to 64 years had similar disease progression as their white counterparts, they would see more than 70% fewer hospitalizations when compared with baseline, whereas the American Indian or Alaska Native and Hispanic groups saw over 50% and 37% reduction in influenza hospitalizations, respectively, in age groups younger than 65 years, according to the study.
Reducing contacts in the workplace also led to a “modest decrease” in hospitalizations, with American Indian or Alaska Native groups seeing the highest reduction observed (50% in the 50 to 65 year age group).
The intervention that had the greatest impact on inequities, however, was reducing comorbidities in BIPOC populations, which resulted in a 40% reduction in hospitalizations across groups.
“Importantly, the strategies that we tested all decreased the number of flu cases and hospitalizations in all groups, not only in the BIPOC groups,” Matrajt concluded.
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