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Social inequalities explain racial gaps in pandemic, studies find

When Dr Gbenga Ogedegbe began researching coronavirus infections in black and Hispanic patients, he thought he knew what he would find. Infected black and Hispanic patients are said to be more likely to be hospitalized than white patients and more likely to die.

But that’s not how it happened.

Dr Ogedegbe, director of the division of health and behavior at the Grossman School of Medicine at New York University, and his colleagues reviewed the medical records of 11,547 patients from the NYU Langone Health System who were tested for a coronavirus infection between March 1 and April 8. .

After accounting for various disparities, Dr Ogedegbe found that infected black and Hispanic patients were no more likely than white patients to be hospitalized. When admitted to hospital, black patients had a slightly lower risk of dying.

“We were surprised,” said Dr Ogedegbe.

The study was published in the journal JAMA Network Open. Three other major recent studies have come to similarly surprising conclusions.

The new findings do not contradict a huge body of research showing that black and Hispanic Americans are more likely to be affected by the pandemic than whites. The coronavirus is more prevalent in minority communities, and infections, illnesses and deaths have occurred in these groups in disproportionate numbers.

But the new studies suggest that there is no innate vulnerability to the virus in black and Hispanic Americans, said Dr Ogedegbe and other experts. Instead, these groups are more often exposed due to social and environmental factors.

“We hear this all the time – ‘Blacks are more sensitive,’ Dr Ogedegbe said. “It’s all about exposure. It all depends on where people live. It has nothing to do with genes.

Among many other vulnerabilities, black and Hispanic communities and households tend to be more overcrowded; many people have jobs that require frequent contact with others and depend on public transport. Access to health care is poorer than among white Americans, and the rates of underlying conditions are much higher.

“To me, these results clearly show that the disparities in mortality that we are seeing are even more appalling,” said Jon Zelner, an epidemiologist at the University of Michigan who led one of the new studies.

The record of black and Hispanic Americans “could easily have been improved before the pandemic by a less worn and cruel approach to welfare and health care in the United States,” he added. “Even without that, a lot of it could have been avoided.”

For example, the federal government could have protected citizens from risky work situations by offering them income grants that allowed them to stay at home, Dr. Zelner said. The government could have guaranteed adequate protective equipment for workers in retirement homes and long-term care facilities.

Dr Zelner and his colleagues looked at data on 49,701 coronavirus patients in Michigan, hospitalized and not, from March through June. In this population, the case fatality rate was the same for black and white patients: 11 percent.

(The high rate reflects the fact that the incidence in Michigan at the start of the epidemic was dominated by the elderly, Dr Zelner said. And the data is for cases detected, rather than all infections during that period. , at a time when there was much less testing.)

A study of veterans’ hospital patients, led by Dr Christopher Rentsch of the London School of Hygiene and Tropical Medicine and researchers at the VA, analyzed the health records of more than five million patients in more than 1,200 establishments.

Some 16,317 have tested positive for the coronavirus. Among them, Dr. Rentsch found that there was no difference in death rates between white, black, or Hispanic patients.

Investigators expected the underlying health conditions to lead to a higher death rate in black and Hispanic patients, who are more likely to suffer from conditions such as obesity and increasing high blood pressure. the risk of severe Covid-19.

But in the analysis of the death rate, these conditions “barely moved him,” said Dr Rentsch. Health disparities by race among VA patients, however, tend to be smaller than among Americans overall, he warned.

A study in New Orleans, led by Dr Eboni Price-Haywood, who heads the Ochsner Center for Outcomes Research and Health Services, included the 3,481 patients who tested positive for the coronavirus between the 1st March and April 11.

Black and white patients had the same case fatality rate, she and her colleagues found.

It‘s always confusing when people read the newspaper,” Dr. Price-Haywood said in an interview. But, she added, by the time someone was sick enough to be hospitalized, race became irrelevant.

“If you were fragile enough to be admitted, you were fragile enough to die,” said Dr. Price-Haywood.

All four studies confirmed marked differences in the incidence of coronavirus infection in minority and white patients.

In Dr. Ogedegbe’s study, black and Hispanic patients were 60 to 70 percent more likely than whites to be infected. In research in Michigan, the incidence of infection among blacks was four times higher than among whites.

“If you were to replace the incidence rates of whites with blacks, you would see an 83% reduction in mortality,” Dr. Zelner said.

In the VA study, nine of 1,000 white veterans tested positive for coronavirus, compared to 16.4 out of 1,000 in black patients. In New Orleans, black patients made up 76.9% of those hospitalized for Covid-19, although they made up only 31% of the health system population.

These differences are fully explained by socio-economic factors, the researchers said.

“The biggest problem is the role of the social determinants of health,” said Dr. Price-Haywood. “Race is a social construct, not a biological one.”