COVID-19 Racial Disparities Research Articles

Racial Disparities in COVID-19 Impacts in Michigan, USA.

Racial disparities have been observed in the impacts of COVID-19 in the USA. In the present paper, we used a representative sample of adults in Michigan to examine differences in COVID-19 impacts on Blacks and Whites in four domains: direct, perceived, political, and behavioral. We found that in the initial wave of the outbreak in May 2020, Blacks experienced more severe direct impacts: they were more likely to be diagnosed or know someone who was diagnosed, and more likely to lose their job compared to Whites. In addition, Blacks differed significantly from Whites in their assessment of COVID-19’s threat to public health and the economy, the adequacy of government responses to COVID-19, and the appropriateness of behavioral changes to mitigate COVID-19’s spread. Although in many cases these views of COVID-19 were also associated with political ideology, this association was significantly stronger for Whites than Blacks. Continued investigation of racial disparities in COVID-19’s impact is necessary; however, these preliminary findings of a race-by-ideology interaction are important because they suggest some racial disparities are restricted to conservatives, while more liberal Whites and Blacks exhibit few differences.

The Relationship Between Social Determinants of Health and Racial Disparities in COVID-19 Mortality.

BackgroundThe COVID-19 pandemic has magnified existing health disparities for marginalized populations in the United States (U.S.), particularly among Black Americans. Social determinants of health are powerful drivers of health outcomes that could influence COVID-19 racial disparities.MethodsWe collected data from publicly available databases on COVID-19 death rates through October 28, 2020, clinical covariates, and social determinants of health indicators at the U.S. county level. We utilized negative binomial regression to assess the association between social determinants of health and COVID-19 mortality focusing on racial disparities in mortality.ResultsCounties with higher death rates had a higher proportion of Black residents and greater levels of adverse social determinants of health. A one percentage point increase in percent Black residents, percent uninsured adults, percent low birthweight, percent adults without high school diploma, incarceration rate, and percent households without internet in a county increased COVID-19 death rates by 0.9% (95% CI 0.5%–1.3%), 1.9% (95% CI 1.1%–2.7%), 7.6% (95% CI 4.4%–11.0%), 3.5% (95% CI 2.5%–4.5%), 5.4% (95% CI 1.3%–9.7%), and 3.4% (95% CI 2.5%–4.2%), respectively. Counties in the lowest quintile of a measure of economic privilege had an increased COVID-19 death rates of 67.5% (95% CI 35.9%–106.6%). Multivariate regression and subgroup analyses suggested that adverse social determinants of health may partially explain racial disparities in COVID-19 mortality.ConclusionsThis study demonstrates that social determinants of health contribute to COVID-19 mortality for Black Americans at the county level, highlighting the need for public health policies that address racial disparities in health outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-020-00952-y.

Supplemental Material for Black–White Racial Disparities in COVID-19: Awareness and Framing of Decision-Making Rationales

Supplemental Material for Black–White Racial Disparities in COVID-19: Awareness and Framing of Decision-Making Rationales

Differences in the Risk of Health Outcomes in COVID-19 Continuum for African Americans in Healthcare Settings: A Systematic Review and Meta-Analysis

Background: African Americans/Blacks represent the major health disparities population in the US. Thus, we performed a systematic review of published work to quantitatively assess outcome-dependent differences across the COVID-19 continuum among African Americans compared to Whites and other races.Methods: We searched the MEDLINE, Scopus, and Cochrane Library up to March 31, 2021, to identify studies that treated African Americans as an independent racial group and assessed the risk of SARS-CoV-2 infection and/or the subsequent COVID-19 outcomes in US healthcare settings. We used random-effects meta-analysis to generate unadjusted and adjusted pooled estimates of odds ratio (OR) or hazard ratio (HR)/risk ratio (RR) of the racial differences in the risk of each COVID-19 outcome. Graphs were constructed to visualize the trends in racial disparities along the COVID-19 continuum. This study is registered with PROSPERO, CRD42021239596.Findings: Of the 9863 articles identified, 78 were eligible for qualitative synthesis and 67 for meta-analysis. Compared to Whites, the higher risks of COVID-19 outcomes for Blacks continued to decrease along the continuum, from substantial disparities in SARS-CoV-2 infection (adjusted OR [95% CI], 1·96 [1·65–2·34]) and hospitalization (adjusted OR [95% CI], 1·49 [1·26–1·75]) to becoming minimal in infection fatality (adjusted OR, 1·00; adjusted HR/RR, 0·99) or reversed in in-hospital mortality (adjusted OR [95% CI], 0.83 [0·71–0·96]; adjusted HR/RR [95% CI], 0·86 [0·78–0·95]). Compared to other racial minorities, Blacks had higher risk of hospitalization or infection fatality but similar risk of infection or in-hospital mortality. Although Black COVID-19 patients had higher prevalence of most comorbidities than non-Black non-White patients, certain comorbidities or risk factors were more prevalent among White patients compared to other races.Interpretation: The magnitude and direction of COVID-19 racial disparities varied by outcomes. Once the COVID-19 patients received hospital care, there were no differences in outcomes among different races, despite pre-existing disparities.Funding: This work is supported by the US National Institute on Minority Health and Health Disparities of the National Institute of Health, award number U54 MD013376 to YCC.Declaration of Interest: None to declare.

461. Presentation and Demographics of Veterans Tested for COVID-19 Infection

BackgroundCOVID-19, caused by the Severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-CoV-2), has been a major cause of morbidity and mortality in the United States since its emergence in Wuhan, China. As of June 2020, there are over 20,000 confirmed cases and nearly 700 deaths due to COVID-19 in Wisconsin, with the majority of COVID-19 related deaths occurring within Milwaukee County. COVID-19 infections are disproportionately affecting minority communities across the United States. Presentation and outcomes vary, with the elderly and those with underlying diseases having poorer outcomes.MethodsThis retrospective chart review of patients tested for COVID-19 infection from March 2020-May 2020 at the Zablocki VA Medical Center, Milwaukee, WI evaluated demographics, comorbidities, presenting symptoms, and duration of symptoms. The primary outcomes analyzed were whether there were significant differences in demographic data, comorbidities, and presentation between patients testing positive or not positive for COVID-19.ResultsA total of 173 patients tested for COVID-19 were included during the study period, 82 positive and 91 otherwise. Univariate analysis of patient demographics and presenting symptoms are summarized in Table 1. A multivariable logistic regression using stepwise selection (AUC=0.7188) determined patients that tested positive for COVID-19, when controlling for demographics and comorbidities, were more likely to be African-American than White (OR 3.455, CI 1.733–6.887), and more likely to have a diagnosis of diabetes (OR 2.698, CI 1.36–5.353). However, race and diabetes were not informative when symptoms were included in a subsequent model (AUC=0.8458); patients testing positive for COVID-19 were more likely to present with diarrhea (OR 6.926, CI 1.760–6.926) and a higher temperature (OR 2.651, CI 1.533–4.584), but less likely to present with vomiting (OR 0.007, CI < .001-0.161) when compared to patients testing otherwise for COVID-19.Table 1: Univariate Analysis of Variables Associated with Testing Positive for COVID-19 at Zablocki VA Medical Center 3/2020–5/2020 ConclusionPatients testing positive in Milwaukee County are more likely to be African-American and/or diabetic; further highlighting racial disparities in COVID-19. Symptomology at presentation is more related to positive COVID-19 test results than demographics and comorbidities.Disclosures All Authors: No reported disclosures

New pathogen, same disparities: why COVID-19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic.

IntroductionThe U.S. Ending the HIV Epidemic (EHE) Initiative was launched nationally in February 2019. With a target of ending the HIV epidemic by 2030, EHE initially scales up effective HIV prevention and care in 57 localities that comprise the greatest proportion of annual HIV diagnoses in the United States (US). However, the EHE effort has been eclipsed by another infectious disease 11 months into the Initiative’s implementation. SARS‐COV‐2, a novel coronavirus, has infected more than eight million Americans and at least 223 000 (as of 23 October 2020) have succumbed to the disease. This commentary explores the social conditions that place communities of colour at greater risk for COVID‐19 and HIV, and assesses challenges to EHE in a post‐COVID‐19 universe.DiscussionOne of the many common threads between HIV and COVID‐19 is the disproportionate impact of each disease among communities of colour. A recent report by the National Academy of Sciences surmised that as much as 70% of health outcomes are due to health access, socio‐economic factors and environmental conditions. Social determinants of health associated with greater HIV burden in Black and Brown communities have re‐emerged in epidemiological studies of disproportionate COVID‐19 cases, hospitalizations and deaths in communities of colour. Using data from the scientific literature, this commentary makes direct comparisons between HIV and COVID‐19 racial disparities across the social determinants of health. Furthermore, I examine three sets of challenges facing EHE: (1) Challenges that hamper both the EHE and COVID‐19 response (i.e. insufficiently addressing the social determinants of health; amplification of disparities as new health technologies are introduced) (2) Challenges posed by COVID‐19 (i.e. diverting HIV resources to address COVID‐19 and tapering of EHE funding generally); and (3) Challenges unrelated to COVID‐19 (i.e. emergence of new and related health disparities; repeal of the Affordable Care Act and long‐term viability of EHE).ConclusionsRacism and discrimination place communities of colour at greater risk for COVID‐19 as well as HIV. Achieving and sustaining an end to the U.S. HIV epidemic will require structural change to eliminate conditions that give rise to and maintain disparities.

Racial Disparities in Frontline Workers and Housing Crowding During COVID-19: Evidence from Geolocation Data

We document that racial disparities in COVID-19 in New York City stem from patterns of commuting and housing crowding. During the initial wave of the pandemic, out- of-home activity related to commuting is strongly associated with COVID-19 cases at the ZIP Code level and hospitalization at an individual level. After layoffs of essential workers decreased commuting, case growth continued through household crowding. A larger share of individuals in crowded housing or commuting to essential work are Black, Hispanic, and lower-income. As a result, structural inequalities, rather than population density, help determine the cross-section of COVID-19 risk exposure in urban areas.

Using the right words to address racial disparities in COVID-19

Reports continue to show prevailing racial inequalities in COVID-19 outcomes.1 However, most of these reports rely on language that is not necessarily constructive or appropriate in framing how racial health disparities are experienced in terms of who is affected and how social structures contribute to these resulting inequalities. We propose three ways in which we can steer scholarly discussion surrounding racial inequalities and COVID-19 that better encapsulates those affected and why.

Racial Disparities in COVID-19: Present from Diagnosis to Death

Many have reported that Black people have been disproportionately affected by COVID-19. Investigators at Ochsner Health System in Louisiana have now

Understanding COVID-19 risks and vulnerabilities among black communities in America: the lethal force of syndemics

Black communities in the United States are bearing the brunt of the COVID-19 pandemic and the underlying conditions that exacerbate its negative consequences. Syndemic theory provides a useful framework for understanding how such interacting epidemics develop under conditions of health and social disparity. Multiple historical and present-day factors have created the syndemic conditions within which black Americans experience the lethal force of COVID-19. These factors include racism and its manifestations (e.g., chattel slavery, mortgage redlining, political gerrymandering, lack of Medicaid expansion, employment discrimination, and health care provider bias). Improving racial disparities in COVID-19 will require that we implement policies that address structural racism at the root of these disparities.

Bounded Rationality and Organizational Learning

Abstract : If organization theory finds it useful to draw upon some of the ideas that have emerged in cognitive psychology, it will be advantageous to borrow also the terminology used in discussing these ideas. Without working toward a higher level of consistency in terminology than prevails in organization theory today, it will be difficult or impossible to cumulate and assemble into a coherent structure the knowledge we are gaining from individual case studies and experiments. We will be continually reinventing wheels. That is a luxury we cannot afford. The happy band of researchers on organization theory is sufficiently small to be kept fully occupied discovering and verifying the theory just once. (Author) (kr)