Studies find social inequities explain pandemic racial gap
When Dr. Gbenga Ogedegbe began to research coronavirus infections among Black and Hispanic patients, he thought he knew what he would find. Infected Black and Hispanic patients would be more likely to be hospitalized, compared with white patients, and more likely to die.
But that’s not how it turned out.
Ogedegbe, director of the division of health and behavior at New York University’s Grossman School of Medicine, and his colleagues reviewed the medical records of11,547 patients in the NYU Langone Health systemwhowere tested for coronavirus infection between March 1 and April 8.
After accounting for various disparities, Ogedegbe found that infected Black and Hispanic patients were no more likely than white patients to be hospitalized. If hospitalized, Black patients had a slightly lower risk of dying.
“We were surprised,” Ogedegbe said.
The study was published in the journal JAMA Network Open. Three other recent large studies have come to similarly surprising conclusions.
The new findings do not contradict an enormous body of research showing that Black and Hispanic Americans are more likely to be affected by the pandemic, compared with white people. The coronavirus is more prevalent in minority communities, and infections, illnesses and deaths have occurred in these groups in disproportionate numbers.
But the new studies do suggest that there is no innate vulnerability to the virus among Black and Hispanic Americans, Ogedegbe and other experts said. Instead, these groups aremore often exposed because of social and environmental factors.
“We hear this all the time — ‘Blacks are more susceptible,’ ” Ogedegbe said. “It is all about the exposure. It is all about where people live. It has nothing to do with genes.”
Among many other vulnerabilities, Black and Hispanic communities and households tend to be more crowded; many people work jobs requiring frequent contact with others and rely onpublic transportation. Access to health care is poorer than among white Americans, and rates of existing health conditions are much higher.
“To me, these results make it clear that the disparities inmortality thatwe see are even more appalling,” said Jon Zelner, a public health researcher at the University ofMichigan who led one of the new studies.
The toll on Black and Hispanic Americans “could easily have been ameliorated in advance of the pandemic by a less threadbare and cruel approach to social welfare and health care in the U.S.,” he added.
“Even failing that, so much of this could have been avoided.”
For example, the federal government could have protected citizens from risky work situations by providing income subsidies allowing them to stay home, Zelner said. The government could have ensured adequate protective equipment to workers in nursing homes and longterm care facilities.
Zelner and his colleagues examined data on 49,701 coronavirus patients in Michigan, hospitalized and not, from March until June. In this population, the case fatality rate was the same.
The four studies did confirm stark differences in the incidence of coronavirus infection among minority and white patients.
In Ogedegbe’s study, Black and Hispanic patients were 60 percent to 70 percent more likely than whites to be infected. In the research in Michigan, the incidence of infection among Black people was four times higher than that among whites.
“If youwere to substitute the white incidence rates for Black ones, you would see an 83 percent reduction in mortality,” Zelner said.