What do we know about race and COVID?

No, your race doesn’t directly increase your chance of getting COVID. So why does it appear that people of some races are more likely to get sick? The answer is what doctors call social determinants of health, which are some factors that can affect your well-being. 

Social determinants of health are the economic and social conditions that influence individual and group differences in health status (see Figure below). This means that where we live, learn, work, and play affects our health.

Figure. The social determinants of health help us to understanding health disparities related to race or ethnicity and COVID risk. Image source: https://enterprises.upmc.com/blog/social-determinants-of-health/}

According to data from New York City, COVID-19 death rates for Black/African American and Hispanic/Latinx persons were substantially higher than those of white or Asian persons. Social determinants—but not race—can explain these discrepancies. 

Where you live affects your health

Members of minority communities, such as Black, Asian, and Latinx persons, are more likely to live in densely-populated areas. Whether you live in a home or an apartment, a large city or a rural town, may affect how hard or easy it is to take steps to prevent COVID infection. For residents of large apartment buildings, it is more difficult to practice social distancing. 

Where you live also affects how easy or hard it is to get treatment if you do get sick. And, particularly in states that did not expand Medicaid, members of minority communities are likelier to live in poorer areas that may not have easy access to primary health care. 

Where you work affects your health

The type of job you have may also put you at higher risk of getting COVID. People who work in essential industries such as nursing, agriculture, grocery stores, or food preparation must continue to work outside the home despite outbreaks in their communities. Some racial and ethnic minorities are more likely to work in these essential jobs. 

According to recent government data, Hispanic workers account for 17% of working people in the US, but they make up 53% of agricultural workers. Black or African Americans make up 12% of all workers, but account for 30% of licensed practical and licensed vocational nurses. Asian Americans represent 6% of the U.S. population, but they account for 18% of the country’s physicians and 10% of its nurse practitioners. 

Members of minority communities also work at higher rates in service jobs that may not offer sick pay or the option to work from home. This means that they are more likely to have to go to work no matter what, even when sick.

Chronic health conditions can make COVID-19 outcomes worse

Chronic conditions (including diabetes, asthma, high blood pressure, kidney disease, and obesity) are more common in minority communities. This is again due to social determinants of health. These communities are less likely to have health insurance and adequate access to the healthcare system. Dr. Thomas A. LaVeist, Dean of the School of Public Health and Tropical Medicine at Tulane University explains that policy decisions—for example, some poorer states' decision not to expand Medicaid—are also responsible for poor health and higher COVID-19 death rates among African Americans. 

In the end, sometimes our zip code is more important than our genetic code.

 

Last update: May 30, 2020, 5:00pm ET

Science review: ERS, JAB