Systemic Racism & Health Care, COVID & Treatment

COVID-19 hospitalizations: Hospitalization rates per 100,000 population by age and race and ethnicity — COVID-NET, March 1, 2020–January 23, 2021

• NOTE: These data represent lab-confirmed COVID-associated hospitalizations in a network of hospitals in 14 states, representing approximately 10% of the US population. The per-capita rates are age-adjusted. Presented statistics reflect only those hospitalizations where race/ethnicity is known. Lags in data reporting mean the data may be preliminary for the time period covered and are subject to change.

COVID-19 deaths: The COVID Tracking Project, The COVID Racial Data Tracker

• NOTE: Data gathered on 2/2/2021; The COVID Racial Data Tracker manually compiles key statistics from each state and territory public health authority website and other sources and updates their tracker on a daily basis. Represented statistics reflect only deaths where race/ethnicity is known and rates are not age-adjusted.
  • It is worth noting that since the start of the pandemic, the Black-White disparity in deaths has narrowed. At the same time, the gaps have widened for Hispanic and Native American populations. View the trends in this NPR report.

Racial bias in hospital funding:

• Kakani, P., Chandra, A., Mullainathan, S., & Obermeyer, Z. (2020) Allocation of COVID-19 relief funding to disproportionately black counties. JAMA : The Journal of the American Medical Association, 324(10), 1000-1003. doi:10.1001/jama.2020.14978

• Vyas D, Eisenstein L, Jones D. “Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms.” The New England Journal of Medicine, 2020; 383:874-882 DOI: 10.1056/NEJMms2004740

Travel time & testing location: Rader, B., Astley, C. M., Sy, K. T. L., Sewalk, K., Hswen, Y., Brownstein, J. S., & Kraemer, M. U. G. (2020). Geographic access to united states SARS-CoV-2 testing sites highlights healthcare disparities and may bias transmission estimates. Journal of Travel Medicine, doi:10.1093/jtm/taaa076

Access to testing resources were initially limited or not available in minority communities: ABC News, FiveThirtyEight analysis, described in “White neighborhoods have more access to COVID-19 testing sites: ANALYSIS,”ABC News

Zip code testing disparities: Axios, People of Color Have Less Access To Coronavirus Testing, June 23, 2020

Rural testing access: Surgo Foundation, New Surgo Analysis Identifies Highly Vulnerable Rural Communities as COVID-19 Testing Deserts, June 17, 2020

Community hospital in NY statistic: The New York Times, Why Surviving the Virus Might Come Down to Which Hospital Admits You, July 1 2020

Study on fewer ICU beds and higher risk of death: Gupta, S., Hayek, et al. (2020) Factors associated with death in critically ill patients with coronavirus disease 2019 in the US. JAMA Internal Medicine, 180(11), 1436-1446. doi:10.1001/jamainternmed.2020.3596

Studies showing decline in vaccine confidence: Pew Research Center, U.S. Public Now Divided Over Whether To Get COVID-19 Vaccine, September 17, 2020

Concerns over lack of diversity in clinical trials: Politico, U.S. Lacks Plan for Getting Vaccine to Communities of Color Devastated by Virus, August 3, 2020

Racial disparities in flu vaccination rates: Kaiser Family Foundation, Racial Disparities in Flu Vaccination: Implications for COVID-19 Vaccination Efforts, September 15, 2020

Racial inferiority theories: Byrd, W. M., & Clayton, L. A. Race, medicine, and health care in the United States: a historical survey. Journal of the National Medical Association, 93(3 Suppl), 11S–34S, 2001

Tuskegee Syphilis study: Centers for Disease Control and Prevention, U.S. Public Health Service Syphilis Study at Tuskegee

Racial bias in algorithms: Obermeyer Z, Powers B, Vogeli C and Mullainathan S. “Dissecting Racial Bias in an Algorithm Used to Manage the Health of Populations.” Science, 36(6464):447-53, October 25, 2019.

False beliefs in pain perception: Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016) Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci USA, , 201516047. doi:10.1073/pnas.1516047113

Trust: The Conversation, Why scientists and public health officials need to address vaccine mistrust instead of dismissing it, October 30, 2008

Lack of representation in health care workforce: charts adapted from Association of American Medical Colleges, Diversity in Medicine: Facts and Figures 2019

Studies on minority patients benefiting from having a minority doctor: The Conversation, Minority patients benefit from having minority doctors, but that’s a hard match to make, February 13, 2020

Immediate & actionable strategies:

Improve locations of COVID-19 testing centers: “In Large Texas Cities, Access To Coronavirus Testing May Depend On Where You Live,” NPR Shots

Increase community outreach & engagement:

• How to Address COVID-19 in Communities of Color, ASTHO Experts Blog
• HHS Initiatives to Address the Disparate Impact of COVID-19 on African Americans and Other Racial and Ethnic Minorities

Diversify COVID-19 clinical vaccine and treatment trials:

• “Increasing diversity in clinical trials: What can doctors, regulators, and patients do?” Medical News Today
• US Food and Drug Administration, “Enhancing the Diversity of Clinical Trial Populations — Eligibility Criteria, Enrollment Practices, and Trial Designs Guidance for Industry”

Provide culturally competent care and translation services: The Importance of Effective Communication in Healthcare Practice, Harvard Public Health Review

Establish equitable distribution plans for treatment & vaccines: Bollyky, T. J., Gostin, L. O., & Hamburg, M. A. (2020). The equitable distribution of COVID-19 therapeutics and vaccines. Jama, 323(24), 2462-2463. doi:10.1001/jama.2020.6641

Prioritize preventive care that may have been forgone during the pandemic: Spillover Effects Of The COVID-19 Pandemic Could Drive Long-Term Health Consequences For Non-COVID-19 Patients, Health Affairs Blog, October 23, 2020. DOI: 10.1377/hblog20201020.566558

Close persistent gaps & racial disparities in flu vaccination: Kaiser Family Foundation, Racial Disparities in Flu Vaccination: Implications for COVID-19 Vaccination Efforts, September 15, 2020

Long term strategies:

Increase access to health insurance and care: Addressing Racial Health Disparities In The COVID-19 Pandemic: Immediate And Long-Term Policy Solutions, Health Affairs Blog, July 20, 2020. DOI:10.1377/hblog20200716.620294

Address determinants of health, i.e. housing & food security: Kaiser Family Foundation, Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity, May 10, 2018

Diversify the workforce and medical school pipeline: How Health Equity Gaps Affect COVID-19 Impact, Blue Cross Blue Shield of Illinois

Support community health workers and centers: Advancing Health Equity Through Community Health Workers and Peer Providers: Mounting Evidence and Policy Recommendations, Families USA

Provide implicit bias and anti-racism training:

• It’s Time To Address The Role Of Implicit Bias Within Health Care Delivery, Health Affairs Blog, January 15, 2020. DOI:10.1377/hblog20200108.34515
• “Managing the COVID-19 Crisis: Tackling Implicit Bias,” Webinar, American Academy of Family Physicians
• “Gov. Whitmer to Require Implicit Bias Training for Medical Licensure,” Michigan Academy of Family Physicians

Work within the community to build trust: Mother Jones, There’s Never Been a More Urgent Moment to Build Black Americans’ Trust in the Medical System, May 8, 2020

Identify & address bias in algorithms & other tools: Brookings, Algorithmic bias detection and mitigation: Best practices and policies to reduce consumer harms, May 22, 2019

Address provider & health system behavior through incentive measures: “Value-Based Health Care Must Value Black Lives, " Health Affairs Blog, September 3, 2020.