Studies show disparate death rates from COVID-19 linked to both poverty and race

An essential worker cleans a New York City subway station in Queens, NY during the COVID-19 pandemic. Marc A. Hermann / MTA New York City Transit (CC BY 2.0).

Long-standing racism and attendant poverty have made the pandemic more hazardous for racial and ethnic minorities, say Harvard public health researchers.

Two recent studies by Harvard University researchers have added striking new details to the story of racial disparities in deaths from the COVID-19 pandemic in the United States.

In a pre-recorded presentation released Oct. 12 as part of the Council for the Advancement of Science Writing’s New Horizons in Science briefings at the virtual ScienceWriters2020 conference, Mary Bassett said the new research affirms that the higher death rates from COVID-19 among racial and ethnic minority groups are rooted in long-standing racism and the poverty that attends it. The data suggest that the death toll has also been higher among poor whites and among people of color not living in poverty.

“We all need to think about how racism works. One of the ways it works is to distribute people of color into lower-income groups and higher-poverty neighborhoods,” said Bassett, François-Xavier Bagnoud professor of the practice of health and human rights at Harvard and former health commissioner for New York City from 2014 to 2018. People’s risk of exposure to the SARS-CoV-2 virus that causes COVID-19, she said, is tied to their living environments, their jobs, and their commutes.

Bassett’s research shows that a young Black person in America is nine times more likely to die from COVID-19 than a young Non-Hispanic White person, and a young Latino person is nearly eight times more likely to die than a young white person. Other people of color in younger age brackets—such as Native Americans/Alaska Natives and Asian Americans—also show elevated mortality rates compared to whites. Overall, among younger adults, members of racial and ethnic minority groups are dying at much higher rates than their same-age white peers.

With access to national COVID-19 fatality data tied to race, Bassett and her colleagues at Harvard’s FXB Center for Health and Human Rights have studied these racial disparities in detail. In a working paper released in June, they quantified the unequal mortality rates using a particularly sobering statistic: the potential years of life lost.

Analyzing data from the National Center for Health Statistics, they calculated that more than 138,000 collective years of potential life were lost to COVID-19 between February and May 2020 in the United States. Although people of color account for just under 40 percent of the U.S. population, they account for about 75 percent, or 105,000, of those lost years.

Such dramatic health inequities need to be brought to the forefront of the national conversation about COVID, Bassett said, a goal that requires more data. She specifically called for more research broken down not only by race, but also by gender, educational attainment, and employment. Looking at the relationships among these demographic factors can help paint a more nuanced picture, she added, and better inform policymakers.

Poverty, racism, and a pandemic: a deadly combination

In a study released as a preprint on the medRxiv archive Oct. 6, Bassett and her colleagues were able to do just that, she said, for data from Cook County, Illinois, home to the city of Chicago. They examined the effect of neighborhood poverty on COVID-19 mortality within racial and ethnic groups in Cook County.

Mortality by census tract poverty rate quartile
Mortality rates for each racial/ethnic group across neighborhood poverty levels in Cook County, Illinois. The rates are adjusted for differences in age and gender distribution among racial/ethnic groups. From Feldman & Bassett 2020 (CC BY-NC-ND 4.0).

Across all racial groups, whites included, they found that those living in the highest-poverty neighborhoods were between 1.6 and 4.1 times more likely to die of COVID than those of their same race or ethnicity living in the most affluent neighborhoods. Adjusting for the differences in age and gender distribution among racial and ethnic groups, in the poorest neighborhoods, white and Black people under 65 years old had similarly high mortality rates of about 35 in 100,000 people.

The data, Bassett explained, show that poverty itself is likely a major risk factor for getting and dying of COVID. “In all race groups, we see a gradient by area-based poverty. People who live in the wealthiest neighborhoods, regardless of their race or ethnicity, had the lowest COVID mortality rate among their race or ethnic group.”

However, she added, racial disparities remain, even among the rich and elderly. Among the wealthy in Cook County, Black and Latino people under 65 were almost three times more likely to die from COVID than their white neighbors. Among the elderly, the wealthiest Blacks and Latinos had a higher chance of dying from COVID than the poorest whites.

Bassett told her audience of science journalists and other communicators that “contextualizing” racial disparities in their reports is essential to the public understanding of COVID-19, and to the development of policies designed to end the health inequities in the COVID response.

She pointed to the example of low-wage essential workers such as meatpackers, farm workers, and grocery store clerks, jobs that employ disproportionately high numbers of people belonging to racial and ethnic minority groups. With no option to telecommute and mostly denied paid sick leave, they are at elevated risk of exposure to the SARS-CoV-2 virus.

Ideally, she said, researchers need access to individual-level data from counties, states, and the federal government. She said these data are collected, but are not generally available to researchers.

The conversation should stay focused on the data, she said, and journalists have a big role to play. “This is a story that should not get old.”

Juliana Nazaré (@ju1es_) is a recent PhD graduate from MIT, where she studies human-machine systems that help children learn to read and write. She wrote this story as a participant in the ComSciCon-SciWri workshop at ScienceWriters2020.