Isolation

Bringing Health Disparities into Plain View

Health disparities are an ever-present feature of American healthcare. Money, race, and ethnicity have long been deciding factors in who lives and who dies. Chronic diseases have their greatest impact on black, Hispanic, and economically disadvantaged communities. Prevalence is higher. But access to treatment is lower. It’s equally true for diabetes, heart disease, and obesity. Now, with the pandemic of COVID-19, this life-or-death story of health disparities is coming into plain view.

Everywhere we look, the COVID-19 pandemic is most devastating to African Americans.

Disparities in Chronic Diseases

These disparities are nothing new. Obesity is almost 20 percent more prevalent in black Americans than in whites. But if you look at severe obesity, the prevalence is closer to 50 percent higher. Not surprisingly, that translates into higher rates of diabetes, heart disease, and other chronic diseases that result from obesity.

However, access to medical care does not match the higher need in this community. In fact, it’s just the opposite – both in terms of access to medical care generally and for obesity specifically. Obesity treatment studies tend to enroll mostly white women. So it doesn’t surprise us when we read a recent review of disparities in obesity care and learn that well-established obesity treatments “are less effective in racial and ethnic minorities.” Intentionally or not, they’re tailored to the needs of a different population. This fact magnifies the problem of poor access to care in the first place.

Disparities in Death

It’s becoming plain to see that the risk of death in COVID-19 is higher for African Americans. CDC released a new analysis yesterday in the MMWR that showed African Americans are a third of the patients hospitalized with COVID-19 – even though they are only 13 percent of the population. That means that the likelihood of a black person being hospitalized with COVID-19 is nearly three times higher than the rest of the population.

In Chicago, black citizens account for more than half of all COVID-19 cases and 70 percent of the deaths. But they make up only 30 percent of the city’s population. This is a disproportionate burden of death that is unconscionable.

The Impulse to Look Away

These disparities are hard to explain in definitive terms. Many factors can contribute. The pre-existing burden of disease makes African Americans more vulnerable to bad outcomes from COVID-19. However, that’s not the whole story. It’s also likely that economic circumstances make it more difficult for this population to remove themselves from exposure. To some extent, sheltering at home is an economic and occupational privilege.

The impulse to look away from health disparities is unacceptable. Information on this problem is still spotty. In many places, data on racial disparities are simply not available. Harvard physician Fatima Cody Stanford tells us we can do better:

Like many acute and chronic illnesses that our country faces, we are seeing that COVID-19 disproportionately impacts communities of color – with specific emphasis on the African-American community. We also know that obesity is a significant risk factor for poor outcomes related to COVID-19. But we need better data regarding these patients so we can better determine the causal factors.

Click here, here, and here for more on disparities in COVID-19 outcomes. For Stanford’s presentation on disparities in obesity treatment at last year’s Blackburn Course in Obesity Medicine, click here.

Isolation, photograph © Lu Yu / flickr

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April 9, 2020

3 Responses to “Bringing Health Disparities into Plain View”

  1. April 09, 2020 at 8:59 am, Cary Conway said:

    We can’t look away and we can and must do better. The National Alliance of Healthcare Purchaser Coalitions is holding an employer town hall on social determinants in the context of COVID-19 next Monday, April 13 from 5-6 pm Eastern. The webinar is complimentary and those who would like to listen in can register here: https://register.gotowebinar.com/register/5706605392112776203

  2. April 09, 2020 at 4:20 pm, Ted said:

    Thank you, Cary, for highlighting the good work of the national Alliance.

  3. April 11, 2020 at 10:13 am, David Brown said:

    Disparities in COVID-19 deaths may have more to do with genetics than with access to medical care. In an article entitled Population Differences in Proinflammatory Biology: Japanese have Healthier Profiles than Americans, the authors note that “Serum sIL-6r was higher in Japanese than Americans, but was most notably low in African-Americans. Our cytokine data concur with national differences in the prevalence of age-related illnesses linked to inflammatory physiology, including cardiovascular disease.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039107/

    Excerpt from article entitled COVID May Trigger ‘Cytokine Storm’ in Some Cases: It’s called a “cytokine storm … When it happens, the immune system keeps working, but at a potentially lethal level.” https://www.webmd.com/lung/news/20200409/why-is-covid-19-sometimes-severe-in-young-adults#1

    What’s important is that arachidonic acid status potentiates a cytokine storm. https://www.ncbi.nlm.nih.gov/pubmed/12693944