Differences in RAAS/vitamin D linked to genetics and socioeconomic factors could explain the higher mortality rate in African Americans with COVID-19

Abstract

COVID-19 is said to be a pandemic that does not distinguish between skin color or ethnic origin. However, data in many parts of the world, especially in the United States, begin to show that there is a sector of society suffering a more significant impact from this pandemic. The Black population is more vulnerable than the White population to infection and death by COVID-19, with hypertension and diabetes mellitus as probable predisposing factors. Over time, multiple disparities have been observed between the health of Black and White populations, associated mainly with socioeconomic inequalities. However, some mechanisms and pathophysiological susceptibilities begin to be elucidated that are related directly to the higher prevalence of multiple diseases in the Black population, including infection and death by COVID-19. Plasma vitamin D levels and evolutionary adaptations of the renin-angiotensin-aldosterone system (RAAS) in Black people differ considerably from those of other races. The role of these factors in the development and progression of hypertension and multiple lung diseases, among them SARS-CoV-2 infection, is well established. In this sense, the present review attempts to elucidate the link between vitamin D and RAAS ethnic disparities and susceptibility to infection and death by COVID-19 in Black people, and suggests possible mechanisms for this susceptibility.

Association between Hypomagnesemia, COVID-19, Respiratory Tract and Lung Disease

“…The pandemic Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is characterized by relevant differences regarding the severity of the disease and the case fatality rate (CFR) across different geographical areas. The high CFR observed in some regions has been hypothesized to be due to multiple factors, such as poor distancing measures, co-morbid conditions, climate [ 1 ], pollution [ 2 ] health system facilitating access to care [ 3 , 4 ], genetic characteristics of populations [ 5 , 6 ] and distribution by the age of populations, with vulnerability for communities with a high percentage of older adults [ 7 ]. The complexity of COVID-19 is also related to the multiple molecular pathways triggered by SARS-CoV-2, which is able to cause type I pneumocyte death, trigger intravascular coagulation [ 8 ], interfere with the renin-angiotensin system, dysregulate iron metabolism, ending with the insurgence of a cytokine storm which may lead to death [ 9 ].…”

The Covid-19 Incidence in Italian Regions Correlates with Low Temperature, Mobility and Pm10 Pollution but Lethality Only with Low Temperature

“…The study seems to indicate that the spread of the COVID-19 epidemic in the Italian regions is closely related to environmental variables such as pollution of PM10 (indirect correlation with indices of air purity), the number of beds occupied in hotels (index of the mobility of people, correlation direct) and temperature (indirect correlation), On the contrary, the lethality of the virus measured as CFR inversely correlated with the temperature alone. This work focused on a specific interest because it is known that the study of environmental factors is often affected by co-variables that are not always easy to treat, such as potential confounders, including social distancing, 18 , 19 models of health systems influencing access to care, 20-23 genetic profiles of populations, 24 , 25 and differences in phases of an outbreak in different countries. 26 In this case, we are working on a population in which most of these variables are balanced.…”

Ethno-racial disparities in COVID-19 morbidity and mortality

“…Similarly to the study discussed above, the research team of Martín Giménez et al (2020) point to the coexistence of genetic and socio-economic factors in the high mortality rates among African-Americans in the United States. Considering sociodemographic and socio-economic explanations insufficient, the researchers seek to attribute these ethno-racial disparities in COVID-19 morbidity and mortality to genetic grounds, namely vitamin D deficiency/insufficiency and hypertension related to the peculiarities of the renin-angiotensin-aldosterone system (RAAS) (that is the regulatory system of autonomous, cardiovascular and pulmonary functions).…”