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Living and Working Conditions Explain Racial Disparities in COVID-19 Deaths

Family visiting during COVID-19.

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Key Takeaways

  • The majority of recorded COVID-19 deaths in the United States so far have been of BIPOC people.
  • Several recent studies have attempted to explain the disparity.
  • The studies all separately found that social and environmental factors alone act as determinants of COVID-19 infection risk; race does not play a role.
  • Since BIPOC people, especially Black and Latinx people, are more likely to live and work in high-exposure areas, they are in greater danger of contracting the virus.

Four recent studies are exploring why BIPOC individuals are dying from COVID-19 at the highest rates. And all four independently concluded that the racial disparity most likely has a root cause: social inequities of housing, employment, transportation, and access to health care. The studies were published in the journals JAMA Network Open, PLOS Medicine, Clinical Infectious Diseases, and The New England Journal of Medicine, respectively. 

Their results were “statistically significant,” meaning that they are not likely to be the product of chance, Jessica Cerdeña, a Robert Wood Johnson Foundation health policy research scholar and author of a recent viewpoint on the presence of racial bias in medicine, tells Verywell.

How Has the Pandemic Affected Minority Groups? 

The pandemic’s disproportionate impact on BIPOC communities has been well-documented. Of the 300,000-plus people who have died from COVID-19 in the United States so far more than half were Black, Latinx, and Indigenous. People who identify as Black, for example, currently account for 18% of pandemic deaths despite constituting only 13.4% of the national population.

Despite the publicity it has received, however, the disparity persists. According to Centers for Disease Control and Prevention (CDC) statistics on COVID-19 infections and deaths:

  • Latinx people are 1.7 times as likely as White people to contract the virus and 2.8 times as likely to die of it
  • Black people are 1.4 times as likely as White people to contract the virus and 2.8 times as likely to die of it
  • Indigenous people are 1.8 times as likely as White people to contract the virus and 2.6 times as likely to die of it (“Indigenous” here refers to American Indians and Alaska natives)

Asian and Asian American people are also at higher risk, although to a lesser degree.

However, Ron Garcia, PhD, former director of the Center of Excellence for Diversity in Medical Education at the Stanford University School of Medicine, cautions against the tendency—prevalent in science, medicine and health care—to lump diverse groups of people together based on the fact that they share a single racial or ethnic characteristic. 

“I feel the labels of ‘Black’ and ‘Latinx’ are so global that [it] is difficult to render a meaningful interpretation when used in these kinds of studies," he tells Verywell. "For example, the term ‘Latinx’ to describe a sample in Los Angeles, Miami, or New York would reference very different groups, but readers would not know. The same concern is true for the use of ‘Asian’ in the literature. These groups vary so much in native as opposed to foreign-born [populations] as well.”

Regardless of any design flaws, the four studies reveal that BIPOC people are dying at higher rates than White people not because they are more genetically or physically susceptible to COVID-19, but because they are more frequently exposed. Black and Latinx people are more likely to live in crowded households, work high-contact jobs, travel by public transportation, and lack health care. 

What This Means For You:

If you live or work in a crowded environment, you have a significantly higher likelihood of contracting COVID-19. If you live in a larger household, consider wearing a mask when in close contact with others in your home. When you can, try to social distance as much as possible in the workplace, and social settings.

The Studies And Their Results 

The studies, which were profiled in The New York Times on December 9, each involved an analysis of data on patients in certain hospitals, health systems, cities, and states. 

  • A December 4 study published in JAMA Network Open consisted of a review of the medical records of 11,547 people in the NYU Langone Health system who had been subjected to COVID-19 testing between March 1 and April 8.
  • A November 21 study published in Clinical Infectious Diseases was based on data on 49,701 Michiganders who had tested positive between March and June.
  • A September 22 study published in PLOS Medicine drew on information on more than five million veterans in more than 1,200 Veterans’ Affairs hospitals.
  • A June 30 study published in The New England Journal of Medicine surveyed “clinical characteristics and outcomes” in 3,481 COVID-19 patients at the Ochsner Center for Outcomes and Health Services Research in New Orleans between March 1 and April 11.

Without exception, the studies found that race alone did not appear to influence COVID-19 infection and mortality risk. 

In fact, Gbenga Ogedegbe, MD, MPH, the lead author of the first study, told the Times that Black patients who had been hospitalized for COVID-19 were actually slightly less likely than White patients who had been hospitalized to die.

“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.”

Black, Latinx, and Indigenous Americans are more likely to contract the virus because of their living and working conditions—not the color of their skin or their cultural heritage. 

How Should the Federal Government Respond? 

The striking BIPOC death toll has fueled calls by academics and celebrities for the CDC to prioritize Black and Latinx people for vaccination. Advocates of the proposal range from the National Academy of Medicine to Melinda Gates.

However, the calls themselves have invited backlash from those who argue that BIPOC people should not be made to serve as medical guinea pigs.

According to Cerdeña, “conditions like homelessness and incarceration often intersect with race due to historical and structural racism, but race alone should not dictate vaccination priority.” Instead, she believes that the most structurally vulnerable among us—including “those who work high-contact jobs, or who are homeless, incarcerated, or undocumented”—should receive the vaccine first. 

Her reasoning hinges on the fact that the structurally vulnerable are more likely to become sick as well as less likely to have access to public or private health services. 

“These individuals face an increased risk of contracting the virus and passing it to others due to limited resources to contain its spread," she says. "Oftentimes, these communities fall at the end of the line for public health interventions, if they receive any consideration.”

The CDC does not take race into consideration when developing a vaccination plan. Phase 1a of the plan, which was made public on December 1, includes healthcare personnel and people living and working in long-term care facilities.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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