COVID-19 and racism - being Black and being poor can be a death sentence
Today's Managing Health Care Costs Number is 6
It's been a good week to think about racism - as we collectively mourn the deaths of George Floyd, Breonna Taylor and Ahmaud Arberry at the hands of police, and as protesters in all 50 states and many other countries protest against police violence and institutional racism.
COVID-19 doesn't discriminate based on race, but clearly our system is putting people of color (and people who are poor) at much higher risk of hospitalization or death from the coronavirus.
American Public Media has collected data from the 40 states (and the District of Columbia) that provide racial identity of those who have died of COVID. Blacks continue to die at over twice the rate of whites. Here are the current stats:
1 in 1,850 Black Americans has died (or 54.6 deaths per 100,000)
1 in 4,000 Latino Americans has died (or 24.9 deaths per 100,000)
1 in 4,200 Asian Americans has died (or 24.3 deaths per 100,000)
1 in 4,400 White Americans has died (or 22.7 deaths per 100,000)
Sutter Health System, a large delivery system in Northern California, published its experience with COVID-19 in Health Affairs. They found that African-Americans were hospitalized at 2.7 times the rates of whites even when they adjusted for age, sex, comorbidities, and income. They used electronic medical record to ascertain race, and zip code tabulation area to impute income. African Americans were much less likely to be tested in an ambulatory setting, and thus perhaps were hospitalized when they were sicker. Regardless of race, those who lived in zip codes representing the bottom quartile of income were four times more likely to be hospitalized than those who lived in zip codes with average or above average income. Income, as well as race, can be a death sentence.
Ochsner Health System, in Louisiana, published its experience with COVID-19 in the New England Journal of Medicine. Black non-Hispanics represent 31% of the Ochsner population, but 70% of those hospitalized. Once hospitalized, the relative mortality of Blacks and Whites was not substantially different.
The New York Times just published a data visualization which lays out starkly the increased risk of six chronic diseases (chronic obstructive lung disease, heart disease, hypertension, diabetes, obesity and kidney disease) based on census tracts. Census tracts that are a majority Black are overwhelmingly more likely to have each of these six chronic diseases, and are overwhelmingly more likely to be impoverished.
For the US, racism is our underlying preexisting condition, and slavery our original sin. As we remake our world post-COVID, we have to do better.
Source: New York Times (Vertical axis is prevalence of each chronic disease; horizontal axis is household income. Census tracts are more with higher share of Black population. You can customize this for your community. Boston is below Click on the image to enlarge)
