Previous evidence has shown Blacks and Latinos to have higher rates of pre-existing health conditions and other health risk factors than whites. But a new study published Tuesday in Health Affairs using pre-pandemic survey data from the Agency for Healthcare Research and Quality found those differences alone were too small to explain the wide racial disparity in COVID-19 outcomes that have occurred since the beginning of the pandemic.
Previous studies that examined the higher rates of severe illness and mortality from COVID-19 that racial and ethnic minorities experience have often explained the disparity in outcomes as the result of a greater prevalence of underlying health conditions found among those populations.
Chronic diseases like Type 2 diabetes, obstructive pulmonary disease, heart and kidney disease, as well as other conditions such as weakened immune systems and obesity, put individuals at any age at increased risk for developing severe illness from COVID-19, according to the Centers for Disease Control and Prevention. Underlying health conditions and advanced age are the leading risk factors for severe illness from COVID-19 among adults, according to the agency.
Blacks and Latinos nationwide are three times as likely to become infected and twice as likely to die from COVID-19 as white individuals, according to the most recent CDC figures.
"We believe that a first step toward correcting racial-ethnic disparities in COVID-19 hospitalization and mortality is to understand what is causing them in the first place," said study lead author Thomas Selden, director of the research and modeling division at AHRQ's Center for Financing, Access, and Cost Trends.
Researchers said COVID-19 disparities were more likely the result of exposure risk related to differing types of employment and household composition.
The study found Blacks who were at high risk of severe illness from COVID-19 were 1.6 times more likely than whites to live in a household with a person who worked in the healthcare field or in the public sector. Among Latino adults at high risk, 64% live in households with at least one person who was unable to work from home, compared with 56% among Blacks and 46% among whites.
Among essential workers, 23% of white workers were able to work from home, compared with just 13% of Blacks and 12% of Latinos.
The average household size was smaller among whites at 2.8 persons, according to the study, versus 3.1 persons for Blacks and 3.8 among Latinos. Overall, 56% of Blacks at high risk of severe COVID-19 illness live in households that had at least person who could not work from home compared with 46% of whites at high risk. Among high-risk Latinos, 64% lived with at least one person who was unable to work from home, increasing everyone within the household's risk of exposure to the virus.
"Although pre-existing conditions likely contributed to the illness severity of minorities infected with COVID-19, it is important to also recognize that whites in the population are, on average, older than minorities—considering age and health together, we found that whites were more likely than minorities to be at high risk of severe COVID-19 illness, convincing us that the explanation for racial-ethnic disparities in COVID-19 outcomes must lie elsewhere."
Selden said the study's findings offer healthcare providers new possibilities to rethink their approaches toward addressing the racial disparity in COVID-19 outcomes.
"If minorities and whites are becoming infected at different rates and part of the problem is workplace exposure, more attention can be focused on researching exposure risks in jobs disproportionately held by minorities and exploring how to mitigate such risks—for all Americans, regardless of racial-ethnic group," Selden said.