Guest column: A brief look into the state of minorities and COVID-19
By Angelica Naylor, MBA, BSN, RN, CCDS
The year 2020: the year that changed all our lives in some form or another. The year 2020: also the year that confirmed racial and ethnic health disparities and inequalities are persistent and worsening for many in our society. Anyone dissenting to this theory before 2020 can no longer ignore the alarming correlations between COVID-19 and minority groups. The longer our country grapples with COVID-19, the more data shows the disease’s worsening toll on the African American, Hispanic, and American Indian communities.
According to The COVID Tracking Project, Native Hawaiians or Pacific Islanders were more likely to contract the coronavirus than other groups; however, African Americans were most likely to die from COVID-19. When compared with their white neighbors:
- African Americans are dying at 2.1 times the rate of White people
- American Indians are dying at more than 1.5 times the rate of White people
- Hispanics are dying at nearly 1.5 times the rate of White people
There is no one simple answer. The causation is multifactorial, with two primary factors: race and income. Before we dive into why race and income are such critical factors to understanding this disparity, let’s look into the clinical factors first.
There is no evidence that African Americans or Hispanics have genetic predispositions or biological indicators that make them more prone to complications of COVID-19. However, they are more affected by and at risk for chronic conditions such as asthma, hypertension, hyperlipidemia, diabetes, and obesity. They are also at an increased risk of mortality from these chronic conditions and complications thereof. Other factors that we now know affect outcomes with COVID-19 can also present a challenge for these populations, as chronic vitamin D and zinc deficiencies often plague minorities, particularly those in the African American population.
A deeper dive and analysis shows that most of these chronic conditions are attributed to inflammation. Historical studies and research determined that increased inflammation is associated with a host of gene variants or genetic mutations. As we know, genes carry the hereditary information, or DNA, in a cell’s nucleus and control production of proteins. That said, although many African Americans and Hispanics are genetically predisposed to many chronic and autoimmune conditions, this does not indicate that 100% of them will develop all the conditions of their parents and grandparents.
Many conditions require an environmental trigger or exposure to develop, which leads us back to race and income disparities. Dr. Roberta Ness, MD, MPH, lead author of a study on racial disparities in health for the American Journal of Epidemiology, once stated, “We know absolutely for certain that a huge determinant of racial disparities are socioeconomic status, living conditions, behaviors… I mean, these are very different in our country between African-Americans and whites. And they are probably a very big part of the picture.”
The Mayo Clinic (2020) cites several risk factors for complications of COVID-19 in people of color, including:
- Underlying health conditions
- Where you live and work
- The type of work you do
- Access to health care
- Dense living conditions
According to the Centers for Disease Control and Prevention (2020), factors that contribute to increased risk include discrimination; healthcare access and utilization; occupation; education, income, and wealth gaps; and housing. A vast amount of minorities work in service industries; live in crowded or multifamily housing; experience financial, physical, or emotional stress; have limited access to healthcare; are more likely to be uninsured; and lack a primary care physician for preventive medicine and therapies.
Now that we are informed on the history and background information, recent research, and the latest statistics, we are compelled as healthcare professionals to act. We must first acknowledge the reality of the data and research, support each other, empathize, and promote fair access to healthcare.
As CDI professionals, we are compelled to do these things and more. Every CDI professional should strive to become more aware, informed, and involved. We should consider an increased focus on social determinants of health (SDOH) and understand that these are substantiated and irrefutable challenges, circumstances, and situations that are significantly affecting patient outcomes, most importantly mortality rates.
We have direct access to changing the landscape on SDOH capture and coding. SDOH have been the buzz in the CDI industry for a couple of years, with an increased emphasis on action and implementation this year. The Department of Health and Human Services has initiatives to address the disproportionate impacts of COVID-19 and disparities among minority groups. These initiatives can be found here.
All of us have been impacted by COVID-19, whether personally or in someone that we know, so we cannot ignore or downplay the staggering statistics revealed by the data and research. This deadly disease is ravaging families, communities, cities, and states with no discrimination among title or class. Consider the plight of minority groups and how we can assist as healthcare professionals when completing our daily routine in CDI and beyond in our communities.
Additional resources and statistics
- Interactive dashboard showing how COVID-19 is affecting states and communities from Emory Healthcare
- Charts from National Public Radio showing COVID-19 outcome disparities
- Information on race and income shaping COVID-19 risk from the Boston University School of Public Health
Editor’s note: Naylor is the CDI consultant and manager at Trust Healthcare Consulting Services, a CorroHealth company, based in Plano, Texas. Contact her at firstname.lastname@example.org. Opinions expressed are those of the author and do not necessarily reflect those of ACDIS, HCPro, or its subsidiaries.