Racial disparities in COVID-19 deaths reveal harsh truths about structural inequality in America.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has unveiled the stark racial disparities that are present in United States (US) and other developed countries today. In recent weeks, several states have released demographic data that highlight the disproportionate rate of COVID-19 infections in racial/ethnic minorities [1. These disparities are likely a result of the structural inequities that minorities face due to factors such as racism, neighbourhood segregation, income, housing and education inequality, and poor access to medical care. These factors underlie healthcare disparities in the United States and place minorities at higher and disparate risk for infection and death from COVID-19 [1-5. Similar findings are also seen in the United Kingdom (UK) with Black Caribbeans making up the largest share of in-hospital and care home deaths from COVID-19 [6. Furthermore, in the UK like the United States, minorities make up a larger proportion of blue-collar essential workers in comparison with White individuals and are more likely to be economically vulnerable to the impact of COVID-19 [6. In the United States, many states have provided individual state-level data, but to our knowledge there are no publications that have pooled together race data from several states. To provide insight into the racial disparity of infection and deaths due to COVID-19 in the United States. We performed an analysis to assess the rates of COVID-19 infection and death by race and ethnicity based on information obtained from the Department of Health websites of sixteen states (New York, New Jersey, Massachusetts, California, Illinois, Florida, Georgia, Connecticut, Maryland, Pennsylvania, Michigan, Texas, Louisiana, Indiana, Ohio and Virginia) that had more than 20 000 cases of COVID-19 as of 9 May 2020. Data were adjusted by the total population of each race in each state according to the 2010 US Census Bureau [7 to obtain the incidence per 100 000 population and then pooled to obtain the summary data (mean and 95% confidence interval (CI)). Fatality rate was calculated by dividing the numbers of deaths by infections. Difference between race was analysed by one-way analysis of variance with Tukey's post hoc test using GraphPad Prism (San Diego, CA). We found that Black and Hispanic patients had higher rates of infection from COVID-19 at 530 (95% CI 312–748) and 652 (95% CI 363–941) per 100 000, which was significantly greater than White (193 (95% CI 120–266)) and Asian patients (194 (95% CI 133–254)). Furthermore, the rate of death in Black patients was highest at 45 (95% CI 23–67) per 100 000 compared to 14–24 per 100 000 amongst other races (Table 1). Whilst Hispanic patients had a higher rate of infection, their rate of death and fatality rate were not higher than other races, which may be due to their smaller representation amongst older age groups [7. In our analysis, Black patients had higher rates of infection and death from COVID-19 which parallels data from some individual states. Our findings highlight the disparities in COVID-19 infections, however, to better understand these inequalities, detailed demographic data including race/ethnicity and underlying comorbidities should be made available by all states. A limitation of this analysis is that many states are lacking data on race as well as comorbidities and confounding factors such as obesity, smoking and age of cases. It also remains to be determined whether there is a genetic difference in susceptibility, especially to severe disease, to COVID-19. Furthermore, these data are preliminary as the number of coronavirus cases continues to increase sharply on a daily basis. The current pandemic has revealed harsh truths about the structural inequalities that minority communities have faced for centuries in the United States. It is past time that we stand up and make important policy changes to address the racial factors and social determinants that underlie health disparities in the United States and other developed countries. All authors have no conflicts of interest directly relevant to the content of this article. Adjoa Anyane-Yeboa: Methodology (equal); Writing-original draft (equal). Toshiro Sato: Conceptualization (equal); Writing-review & editing (equal). Atsushi Sakuraba: Conceptualization;Methodology; Writing-review & editing.