COVID-19 rates higher in US counties with more Black, Hispanic residents

In the United States, rates of COVID-19 were 1.4 times higher than the national average in counties with higher-than-average Black and Hispanic populations, according to recent data.

The findings were published in the Healthiest Communities report released by U.S. News and World Report and the Aetna Foundation, an independent, charitable affiliate of CVS Health.

“The COVID-19 pandemic has brought attention to the existing disparities in our health care system that have a significant impact on underserved communities,” Garth Graham, vice president of community health and chief community health officer at CVS Health, said in a press release. “Using data from the Healthiest Communities rankings can help create insight on how to better address COVID-19 at the community level, while also helping health care organizations develop solutions to combat the health inequities that have plagued our underserved communities for many years.”

COVID-19 death rates higher in Black, Hispanic communities

U.S. News collaborated with researchers from the University of Missouri Extension Center for Applied Research and Engagement Systems to collect and analyze data from nearly 3,000 U.S. counties. In counties with a higher proportion of Black residents (13% or more), the COVID-19 death rate was 1.2 times higher than the national average. In counties with mostly Black residents, the average case and death rates were about double the national average. Data further showed that 20 of the 25 communities with the highest COVID-19 death rate had a Black population above the national average, and eight of these communities had mostly Black residents.

“The disparities in COVID-19 mortality are a current reflection of a longstanding health deficit that African Americans have experienced compared to whites,” Kimberly Jacob Arriola, PhD, MPH, professor of Behavioral, Social and Health Education at Rollins School of Public Health, Emory University, told Healio Primary Care. “While it is extremely disheartening, one should not be surprised that counties that are disproportionately Black bear a substantially greater burden of COVID-19 cases and deaths.”

Some of the highest COVID-19 death rates in the U.S. occurred in Hancock County and Randolph County, Georgia, where Black residents make up about 72% and 62% of the population, respectively. Arriola said these rural counties “face striking health disparities” compared with metropolitan areas and “are under resourced in ways that create the conditions that are ripe for transmission.

Kimberly Jacob Arriola

“The excess burden and death experienced by counties that are majority Black reflect an underinvestment in the public health and health care infrastructure,” she said. “A strong public health infrastructure would provide access to prevention and screening services, a built environment that supports a healthy lifestyle, access to affordable healthy food, and a range of other conditions that support a healthy lifestyle. Without this infrastructure, residents confront the pandemic with greater existing burden of chronic diseases.”

The COVID-19 death rate was also higher in counties with mostly Hispanic residents. In Texas, the death rate correlated with the size of the Hispanic population. Counties with a smaller-than-average population of Hispanic residents had a death rate of 29 per 100,000 residents vs. 47 per 100,000 residents in counties with a higher-than-average Hispanic population and 69 per 100,000 in counties with a mostly Hispanic population.

The findings are similar to research published in the Journal of the American Geriatrics Society that showed COVID-19 was more prevalent in nursing home facilities and assisted-living communities with disproportionately higher numbers of racial and ethnic minority residents. In addition, previous data from the CDC that revealed that COVID-19 hospitalization rates were four to five times higher among patients who are Black, Latino, Native American and Native Alaskan compared with white patients. Former HHS Secretary Louis W. Sullivan, MD, said during the National Medical Association’s virtual convention that this disparity is partly due to a higher incidence of preexisting conditions in non-white patients.

VA study finds no difference in 30-day mortality

Researchers of another study recently published in PLOS Medicine reported that the excessive COVID-19 burden in Black and Hispanic individuals is “not entirely explained by underlying medical conditions.” Christopher Rentsch, MPH, PhD, assistant professor at the London School of Hygiene & Tropical Medicine, and colleagues analyzed the electronic health records of nearly 6 million patients receiving care from Veterans Affairs. More than 250,000 participants were tested for COVID-19 from February 8 to July 22. Among them, 16,317 tested positive and 1,057 died within 30 days of testing.

The data showed that Black and Hispanic participants were more likely than white participants to test positive for COVID-19 (Black vs. white participants, adjusted OR [aOR] = 1.93; 95% Ci, 1.85-2.01; Hispanic vs. white participants, aOR = 1.84; 95% CI, 1.74-1.94). However, there was no significant difference in 30-day mortality rates between Black and Hispanic participants compared with white participants.

“Minority individuals who received a positive COVID-19 test did not appear to have worse outcomes. However, Black and Hispanic individuals were still twice as likely to test positive for COVID-19, even after accounting for underlying health conditions,” Rentsch said in a press release. “Taken together, these findings suggest a substantial excess burden of COVID-19 infection in U.S. minority communities.”

The researchers called for strategies on state and local levels to reduce health disparities and the spread of COVID-19 in vulnerable populations. Arriola said this will require attention to both short-term solutions such as improving access to COVID-19 testing, contact tracing and treatment services, as well as long-term solutions, including the development of a strong public health infrastructure in communities with poor health indicators.

“We have to be serious about committing to improve the health of African Americans and other vulnerable populations,” she said.

References:

• Li Y, et al. J Am Geriatr Soc. 2020;doi:10.1111/jgs.16847.
• Rentsch CT, et al. PLoS Med. 2020;doi:10.1371/journal.pmed.1003379.
• Tempkin-Greener H, et al. J Am Geriatr Soc. 2020;doi:10.1111/jgs.16850.
• U.S. News & World Report. Healthiest Communities. https://www.usnews.com/news/healthiest-communities. Accessed Sept. 21, 2020.