Social Determinants of Health and Health Disparities: COVID-19 Exposures and Mortality Among African American People in the United States

Maness, Sarah B.; Merrell, Laura; Thompson, Erika L.; Griner, Stacey B.; Kline, Nolan; Wheldon, Christopher W.

doi:10.1177/0033354920969169

Cited by 92 publications

(61 citation statements)

References 14 publications

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“…While it remains possible that these associations could at least in part be explained by residual confounding and selection bias, the emergent findings are consistent with patterns observed during the H1N1 pandemic [22][23][24]. Adverse social conditions at the individual and community level, reinforced by systemic issues such as racism [78,79], may increase the likelihood of both COVID-19 infection and poor COVID-19 disease outcomes. Low-income…”

Section: Discussionsupporting

confidence: 72%

Social determinants of COVID-19 incidence and outcomes: A rapid review

et al. 2021

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Early reports indicate that the social determinants of health are implicated in COVID-19 incidence and outcomes. To inform the ongoing response to the pandemic, we conducted a rapid review of peer-reviewed studies to examine the social determinants of COVID-19. We searched Ovid MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials from December 1, 2019 to April 27, 2020. We also searched the bibliographies of included studies, COVID-19 evidence repositories and living evidence maps, and consulted with expert colleagues internationally. We included studies identified through these supplementary sources up to June 25, 2020. We included English-language peer-reviewed quantitative studies that used primary data to describe the social determinants of COVID-19 incidence, clinical presentation, health service use and outcomes in adults with a confirmed or presumptive diagnosis of COVID-19. Two reviewers extracted data and conducted quality assessment, confirmed by a third reviewer. Forty-two studies met inclusion criteria. The strongest evidence was from three large observational studies that found associations between race or ethnicity and socioeconomic deprivation and increased likelihood of COVID-19 incidence and subsequent hospitalization. Limited evidence was available on other key determinants, including occupation, educational attainment, housing status and food security. Assessing associations between sociodemographic factors and COVID-19 was limited by small samples, descriptive study designs, and the timeframe of our search. Systematic reviews of literature published subsequently are required to fully understand the magnitude of any effects and predictive utility of sociodemographic factors related to COVID-19 incidence and outcomes. PROSPERO: CRD4202017813.

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Section: Discussionsupporting

confidence: 72%

Social determinants of COVID-19 incidence and outcomes: A rapid review

et al. 2021

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“…We found that residence in census tracts with extreme socioeconomic vulnerability was over-represented among Black patients, and COVID19 mortality risk was significantly elevated among people who lived in vulnerable areas irrespective of race. Consequently, we infer that socioeconomic vulnerability (and its correlates) including upstream factors (e.g., systemic racism) and what might be related downstream factors (i.e., chronic diseases [32]), not race per se, explain the elevated mortality risk in our sample. Thus, we agree that race is more useful in medical research if viewed as a social construct rather than a biologic factor (particularly in the US) [33,34].…”

Section: Discussionmentioning

confidence: 92%

Elevated COVID19 mortality risk in Detroit area hospitals among patients from census tracts with extreme socioeconomic vulnerability

Sandhu¹,

Korzeniewski²,

Polistico³

et al. 2021

EClinicalMedicine

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Background the incidence of novel coronavirus disease (COVID19) is elevated in areas with heightened socioeconomic vulnerability. Early reports from US hospitals also implicated social disadvantage and chronic disease history as COVID19 mortality risk factors. However, the relationship between race and COVID19 mortality remains unclear. Methods we examined in-hospital COVID19 mortality risk factors in a multi-hospital tertiary health care system that serves greater Detroit, Michigan, a predominantly African American city with high rates of poverty and chronic disease. Consecutive adult patients who presented to emergency departments and tested positive for COVID19 from 3/11/2020 through 4/18/2020 were included. Using log-binomial regression, we assessed the relationship between in-hospital mortality and residence in census tracts that were flagged for extreme socioeconomic vulnerability, patient-level demographics, and clinical comorbidities. Findings a total of 1,015 adults tested positive for COVID19 during the study period; 80% identified as Black people, 52% were male and 53% were ≥ 65 years of age. The median body mass index was 30•4 and the median Charlson Comorbidity Index score was 4. Patients from census tracts that were flagged for vulnerability related to socioeconomic status had a higher mortality rate than their peers who resided in less vulnerable census tracts (β 0.26, standard error (SE) 0.11, degrees of freedom (df) 378, t -value ( t ) 2.27, exp(β) 1.29, p -value 0.02). Adjustment for age category, Black race, sex and/or the Charlson Comorbidity Index score category reduced the magnitude of association by less than 10% [exp(β) 1.29 vs. 1.21]. Black race [ p = 0.38] and sex [ p = 0.62] were not associated with mortality in this sample. Interpretation people who lived in areas flagged for extreme socioeconomic vulnerability had elevated mortality risk in our predominantly African-American cohort of COVID19 patients who were able to seek hospital care during the so-called ‘first wave’ of the pandemic. By contrast, Black race was not associated with mortality in our sample.

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“…This research suggests that structural racism itself should be considered an underlying cause of COVID-19 racial/ethnic disparities. Thus, it provides empirical data to support the view that structural or institutionalized racism must be viewed as the fundamental or root cause of COVID-19-related racial health disparities [60,[66][67][68][69][70][71][72][73][74].…”

Section: Discussionmentioning

confidence: 99%

Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 35 US States and Their Association with Structural Racism

Siegel

Critchfield‐Jain

Boykin

et al. 2021

J. Racial and Ethnic Health Disparities

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Introduction While the increased burden of COVID-19 among the Black population has been recognized, most attempts to quantify the extent of this racial disparity have not taken the age distribution of the population into account. In this paper, we determine the Black–White disparity in COVID-19 mortality rates across 35 states using direct age standardization. We then explore the relationship between structural racism and differences in the magnitude of this disparity across states. Methods Using data from the Centers for Disease Control and Prevention, we calculated both crude and age-adjusted COVID-19 mortality rates for the non-Hispanic White and non-Hispanic Black populations in each state. We explored the relationship between a state-level structural racism index and the observed differences in the racial disparities in COVID-19 mortality across states. We explored the potential mediating effects of disparities in exposure based on occupation, underlying medical conditions, and health care access. Results Relying upon crude death rate ratios resulted in a substantial underestimation of the true magnitude of the Black–White disparity in COVID-19 mortality rates. The structural racism index was a robust predictor of the observed racial disparities. Each standard deviation increase in the racism index was associated with an increase of 0.26 in the ratio of COVID-19 mortality rates among the Black compared to the White population. Conclusions Structural racism should be considered a root cause of the Black–White disparity in COVID-19 mortality. Dismantling the long-standing systems of racial oppression is critical to adequately address both the downstream and upstream causes of racial inequities in the disease burden of COVID-19.

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Social Determinants of Health and Health Disparities: COVID-19 Exposures and Mortality Among African American People in the United States

Cited by 92 publications

References 14 publications

Social determinants of COVID-19 incidence and outcomes: A rapid review

Social determinants of COVID-19 incidence and outcomes: A rapid review

Elevated COVID19 mortality risk in Detroit area hospitals among patients from census tracts with extreme socioeconomic vulnerability

Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 35 US States and Their Association with Structural Racism

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