Racial Disparities in COVID-19 & Heart Disease
What is a racial disparity?
Generally, disparity means “large difference.” A racial disparity occurs when there is a large difference in a certain outcome amongst racial groups. In terms of health outcomes, a racial disparity can occur when a minority group is disproportionately burdened by a certain disease, condition, or risk factor. If there are higher rates of a certain health outcome in a minority racial group, when compared to non-Hispanic whites it is disproportionate because the minority group accounts for less of the population, yet has a higher rate of a particular disease, condition, or risk factor. In many cases, social determinants of health can explain why one group is disproportionately impacted by a certain disease or condition. Social determinants of health are social, economic, structural, and environment factors that can impact one’s health or one’s risk for developing certain health outcomes.
- Limited education
- Lack of access to transportation
- Crime and Lack of recreational space
- Limited access to affordable, healthy food
- Inadequate income and employment benefits
- Lack of Insurance
- Air pollution
- Frequent natural disasters
- Climate change
Racial Disparities in COVID-19
African Americans and Latinx populations are described as disproportionately impacted by COVID-19 because African Americans and Latinx account for less of the population than other groups but are experiencing more severe COVID-19 outcomes when compared to non-Hispanic whites in close geographic proximity (Alcendor 2020). However, African Americans, when compared to all other racial/ethnic groups are more likely to experience positive test results, COVID-19 complications, and death from COVID-19. Social determinants of health such as inadequate transportation, mistrust of the medical community due to history of medical racism, lack of accessibility to necessary resources such as COVID-19 testing, financial barriers, and limited access to technology are all social determinants that influence the disproportionate impact of COVID-19 on Black and Latinx communities nationwide (Akintobi, Jacobs, Sabbs et al. 2020); (Alobuia, Dalva-Baird, Forrester et al. 2020). It has been reported that when compared to white populations the mortality rate for COVID-19 is more than two times higher in Black, Latinx, and Indigenous populations (Berkowitz, Cené, and Chatterjee 2020). One study that analyzed COVID-19 deaths per county in 131 counties across the US found that the mortality rate was six time higher in predominantly Black counties when compared to predominantly non-Hispanic white counties (Alcendor 2020). Significant racial disparities have been reported in terms of knowledge, attitudes, and behavior relating to COVID-19. Racial minorities were also found to be more likely to report negative COVID-19 experiences and take more precautions to reduce risk of infection and transmission of COVID-19 (Alobuia, Dalva-Baird, Forrester et al. 2020).
COVID-19 and Heart Disease
Social determinants of health impact prevalence of pre-existing conditions in Black and Latinx communities such as heart disease, obesity, and diabetes. These factors as well as other social factors place African Americans at an increased risk for heart disease-related COVID-19 complications. Prevalent comorbidities of patients hospitalized with COVID-19 are cardiovascular disease, diabetes, chronic obstructive pulmonary disease, and hypertension. Cardiovascular disease and hypertension have been reported to be associated with the most severe COVID-19 complications (Alcendor 2020); (Alobuia, Dalva-Baird, Forrester et al. 2020).
Black women in particular have been reported to be bearing a disproportionate burden during the pandemic as they are often at greater risk for heart disease than other groups, placing them at a greater risk for COVID-19. Rates of obesity in Black women add to their vulnerability for heart disease and COVID-19 complications. The U.S. Office of Minority Health reports that 4 in 5 Black women are considered overweight or obese, which is the highest rate amongst any group in the nation. Black women are more likely to be the head of their household, further increasing their burden during the pandemic. They are also more likely to be essential workers, which increase their exposure to COVID-19 (AHA).
Racial Disparities in Heart Disease
“The prevalence of hypertension in Blacks in the United States is among the highest in the world.” – American Heart Association 2019 Stat Report
Hypertension prevalence is greater among Blacks in comparison to non-Hispanic whites. Black Americans experience a 50% greater risk for developing hypertension and/or diabetes, and the mortality rate for heart disease is two times more likely for Blacks when compared to non-Hispanic white Americans (Akintobi, Jacobs, Sabbs et al. 2020). African American adults with hypertension are also more likely to have resistant hypertension (hypertension that is harder to treat with medication) when compared to Hispanic and non-Hispanic white adults with hypertension. Among African Americans, racial segregation and neighborhood poverty have also been linked to rates of hypertension in their communities (AHA 2019). The American Heart Association has also reported that lifelong racial discrimination is linked to high blood pressure in Blacks (AHA 2021).
58% Black adults have high blood pressure, which increases their risk for heart attack and stroke- American Heart Association
African American and Latinx communities experience higher rates of heart failure than non-Hispanic whites. Higher rates of heart failure exist in African American women in particular than any other intersection of race and sex in the nation (Virani SS, Alonso A, Benjamin EJ, et al. 2020). However, both African American men and women, especially those ages 35-64, are disproportionately dying from heart failure. Heart failure disparities do not only exist in rates of heart failure, but also among treatment and inclusion in clinical trials. The social determinants of health of bias and racism have been reported to impact this disparity (Smedley, Stith, Nelson, 2003).