Why are people of color more at risk of coronavirus complications?
Answer From William F. Marshall, III M.D.
Research increasingly shows that racial and ethnic minorities are disproportionately affected by coronavirus disease 2019 (COVID-19) in the United States.
According to recent data from the Centers for Disease Control and Prevention (CDC), non-Hispanic American Indian or Alaska Native people had an age-adjusted COVID-19 hospitalization rate about 5.3 times that of non-Hispanic white people. COVID-19 hospitalization rates among non-Hispanic Black people and Hispanic or Latino people were both about 4.7 times the rate of non-Hispanic white people.
While there's no evidence that people of color have genetic or other biological factors that make them more likely to be affected by COVID-19, they are more likely to have underlying health conditions. Having certain conditions, such as type 2 diabetes, increases your risk of severe illness with COVID-19. But experts also know that where people live and work affects their health. Over time, these factors lead to different health risks among racial and ethnic minority groups.
Where you live and who you live with can make it challenging to avoid getting sick with COVID-19 and get treatment. For example, racial and ethnic minority members might be more likely to live in multi-generational homes, crowded conditions and densely populated areas, such as New York City. This can make social distancing difficult.
The type of work you do also may contribute to your risk of getting COVID-19. Many people of color have jobs that are considered essential or can't be done remotely and involve interaction with the public. In the U.S., according to the CDC nearly 25% of employed Hispanic and Black or African Americans work in the service industry, compared with 16% of non-Hispanic white workers. Black or African Americans also account for 30% of licensed practical and licensed vocational nurses. Many people of color also depend on public transportation to get to work. These factors can result in exposure to the virus.
Your access to health care also affects your health risks. Members of racial and ethnic minority groups are more likely to encounter barriers to getting care, such as a lack of health insurance or not being paid when missing work to get care. In 2017, according to the CDC only about 6% of non-Hispanic white people were uninsured, while the rate was nearly 18% for Hispanics and 10% for non-Hispanic Black people.
Racism may also play a role in health risks. The stress of dealing with racial discrimination can take a toll on your body, causing early aging. This has been linked to underlying conditions, which can increase the risk of severe illness with COVID-19.
All of these factors — underlying health conditions, dense living conditions, employment in the service industry or as an essential worker, access to health care and racism — contribute to the impact of COVID-19 on people of color. But these are long-standing issues. Research shows that people of color are often more greatly affected by public health emergencies, such as Hurricane Katrina.
The COVID-19 pandemic highlights the need to promote the health and well-being of racial and ethnic minorities.
Aug. 13, 2020
William F. Marshall, III M.D.
See more Expert Answers
- COVID-19 in racial and ethnic minority groups. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html. Accessed June 17, 2020.
- Hooper MW, et al. COVID-19 and racial/ethnic disparities. JAMA. 2020; doi:10.1001/jama.2020.8598.
- Chowkwanyn M, et al. Racial health disparities and COVID-19 — Caution and context. The New England Journal of Medicine. 2020; doi:10.1056/NEJMp2012910.
- Bhala N, et al. Sharpening the global focus on ethnicity and race in the time of COVID-19. The Lancet. 2020; doi:10.1016/S0140-6736(20)31102-8.
- Double jeopardy: COVID-19 and behavioral health disparities for black and Latino communities in the U.S. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/coronavirus. Accessed June 18, 2020.
- Ferdinand KC, et al. African American COVID-19 mortality: A sentinel event. Journal of the American College of Cardiology. 2020; doi:10.1016/j.jacc.2020.04.040.
- Rodriguez H, et al., eds. Race, class, ethnicity, and disaster vulnerability. In: Handbook of Disaster Research. 2nd ed. Springer International Publishing; 2007.
- Ajilore O, et al. The fire this time: The stress of racism, inflammation and COVID-19. Brain, Behavior and Immunity. 2020; doi: 10.1016/j.bbi.2020.06.003.
- Coronavirus disease 2019 (COVID-19). People of any age with underlying medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed June 30, 2020.
- Rastogi S, et al. The Black population: 2010. U.S. Census Bureau. https://www.census.gov/prod/cen2010/briefs/c2010br-06.pdf. Accessed June 24, 2020.
- Cohen DT, et al. Population trends in incorporated places: 2000 to 2013. U.S. Census Bureau. https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1142.pdf. Accessed June 24, 2020.
- Simons RL, et al. Discrimination, segregation, and chronic inflammation: Testing the weathering explanation for the poor health of black Americans. Developmental Psychology. 2018; doi:10.1037/dev0000511.
- Profile: Black/African Americans. Office of Minority Health. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61. Accessed June 19, 2020.
- Profile: Hispanic/Latino Americans. Office of Minority Health. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64. Accessed June 19, 2020.
- COVID-19 hospitalization and death by race/ethnicity. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html. Accessed Aug. 11, 2020.