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Black Individuals Bear Heavy Burden of COVID-19 Mortality, but Key Geographic Disparities in Health Determinants Exist

A new study published in the Mayo Clinic Proceedings: Innovations, Quality & Outcomes by University of Alabama at Birmingham (UAB) researchers showed that Black individuals have a disproportionately higher COVID-19 mortality burden across all of the United States, which is driven by a high incidence of COVID-19 infection. They found that there are key geographic differences in the distribution of health determinants and COVID-19 mortality patterns.

Vibhu Parcha, MD, a clinical research fellow in the Division of Cardiovascular Disease, says this study was a deep dive into systemic racism in health, which may be driving the high mortality burden seen among Black individuals. The impact of race in health care has been studied in comorbidities such as diabetes, high blood pressure, high cholesterol, preexisting medical conditions (heart attack, cancer, and lung disease), health behaviors (smoking, alcohol use, physical activity) and socioeconomic factors (health insurance status, household income, and education).

In this study, Parcha and his team analyzed data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System survey and COVID-19 mortality data from state public health department databases. This investigation by UAB researchers is the first attempt at looking into race-stratified geographic differences in health determinants and their relationship with COVID-19 mortality using nationwide data.

“Crude mortality is defined as the number of deaths due to COVID-19 in the respective population subgroup, such as within all Black persons or white persons,” Parcha explains. “The infection-fatality ratio is calculated by looking at the number of deaths among people infected with COVID-19. Crude mortality is a measure of the disease burden and explains how badly a population is affected by the deaths due to a disease, whereas infection fatality ratio is a measure of how severely the disease affects those who are infected with the virus.” 

Researchers found that Black individuals in the United States have a higher prevalence of comorbidities and poor socioeconomic conditions. Both Black and white individuals living in the Southern and Midwestern regions of the United States have a higher prevalence of these health determinants. The researchers found that Black individuals have a three-times-higher likelihood of COVID-19 infection and twofold higher crude mortality. They also noted that the infection fatality, the ratio of COVID-19 deaths among those who are infected with COVID-19, was similar between Black and white individuals. 

“COVID-19 is a serious condition that has disproportionately impacted minority populations with key geographic differences within them,” says senior author Pankaj Arora, MD, a physician-scientist in UAB’s Division of Cardiovascular Disease. “The persistent racial disparities in health care, as underlined by our study, may predispose Black individuals to bear a hefty share of the COVID-19 pandemic. These important findings may help inform public health policy not just during the pandemic but also in its aftermath so that we can help address some important and persisting health disparities.”

Arora also added there may be limitations with the study, citing the findings, based on the observed data at the population-level, may be prone to ecological fallacy of being inferred as being consistent at an individual level. Importantly, the pandemic is still evolving, and data are still accumulating. 

“We will have a better understanding of the devastating impact of the pandemic, especially among minority populations, as more data accumulates,” Arora says. “We need urgent efforts to mitigate the systemic racial health disparities that have been heightened during the pandemic. Under the leadership of Dr. Selwyn Vickers, and UAB’s Minority Health and Health Disparities Research Center under Dr. Mona Fouad’s leadership, UAB has been leading efforts in this direction. We are all trying to fight this pandemic together, and I hope, with our resilience and adherence with CDC’s health recommendations, we will overcome these difficult times.”

For up-to-date information about UAB and how to protect yourself, visit uab.edu/coronavirus.

Source: University of Alabama at Birmingham