Black, Hispanic, American Indian and Alaska Native people are at a disproportionate risk of being hospitalized for COVID-19 in 12 states, including Minnesota, according to a University of Minnesota study published Monday in JAMA Internal Medicine.
The study’s findings add to growing evidence of the disproportionate impact that COVID-19 is having on minority communities within the United States. To address those disparities — why non-whites are being hospitalized at much higher rates than whites — all states need to provide more detailed and consistent reporting of COVID-19 hospitalizations, the study’s authors stress.
To conduct their study, researchers used data from the U of M’s COVID-19 Hospitalization Tracking Project to identify all states that reported the race and ethnicity of individuals hospitalized with COVID-19 from April 30 through June 24. Those 12 states — Arizona, Indiana, Kansas, Massachusetts, Minnesota, New Hampshire, Ohio, Oregon, Rhode Island, Utah, Virginia, and Washington — had a total of 48,788 COVID-19 hospitalizations during that two-month period. (Recently, Florida and New Jersey have also begun to report COVID-19 hospitalization data by race and ethnicity.)
The researchers then compared the percentage of hospitalizations for five racial and ethnicity groups — white, Black, Hispanic, American Indian/Alaskan Native and Asian — with each group’s overall share of the populations in the states.
“We found that different states represent different types of disparities,” said Pinar Karaca-Mandic, the study’s lead author and a health economist at the U of M’s Carlson School of Management, in an interview with MinnPost. “But there were some consistent results.”
Here are the key findings:
- In all 12 states, Blacks were hospitalized with COVID-19 at higher rates than whites. That difference was greatest in Ohio, followed by Minnesota, Indiana and Kansas. In Minnesota, blacks make up 6.8 percent of the state’s population, but represented 24.9 percent of the hospitalized COVID-19 patients in the study.
- Whites, on the other hand, made up a significantly smaller share of COVID-19 hospitalizations in all 12 states compared with their share of the population in those states. That was particularly true in Minnesota. Although whites comprise 84.1 percent of Minnesota’s population, they represented only 52.9 percent of the hospitalized COVID-19 patients.
- Hispanics were hospitalized with COVID-19 at higher rates than whites in 10 of the 11 states that reported this data. The largest disparities were in Virginia (where Hispanics comprise 9.6 percent of the population, but made up 36.2 percent of the COVID-19 hospitalizations), followed by Utah and Rhode Island. In Minnesota, Hispanics make up 5.5 percent of the state’s population, but represented 15.5 percent of the COVID-19 hospitalizations.
- American Indian/Alaska Natives were hospitalized with COVID-19 at higher rates than whites in all eight states that reported such data. The biggest disparity was in Arizona, where this group accounted for 15.7 percent of the hospitalizations, but only 4 percent of the state’s population. In Minnesota, American Indians comprise 1.4 percent of the population and represented 2.7 percent of the hospitalized COVID-19 patients in the study.
- Hospitalization disparities were less prominent among Asian communities than among other minority groups. In six of the 10 states that reported data on this group, the share of COVID-19 hospitalizations for Asian Americans was smaller relative to their population within the state. That was not true in Minnesota, however. Although Asians make up 5.1 percent of the state’s population, they represented 9.8 percent of its COVID-19 hospitalizations in the study.
Reducing the inequities
“Our data is not able to really speak to the causes of the disparities that we see, but in our opinion the disparities reflect some of the longstanding structural inequities in our health care system,” said Karaca-Mandic.
Such inequities include unequal access to health insurance and quality health care — “areas where Minnesota is vulnerable in terms of its minority populations,” Karaca-Mandic said. As a result of these and other negative social determinants of health, individuals from minority groups tend to be more likely to have underlying medical conditions, such as heart disease and type 2 diabetes, that put them at greater risk of getting serious ill from COVID-19.
People from minority populations are also more likely to have service-related jobs, such as in the health care or transportation sectors, that cannot be done from home or that are considered “essential” during the current coronavirus pandemic — jobs that put them at a higher risk of exposure to COVID-19, Karaca-Mandic added.
She and her U of M co-authors urge all states to report more demographic information about their hospitalized COVID-19 patients, including breaking down the data by race and ethnicity. That kind of detail can help public health officials reduce the spread of the disease — and save lives.
“It’s not an infection that is affecting everyone in the same way,” said Karaca-Mandic. “But we can now identify communities and groups that are more adversely affected and target resources more appropriately.”
FMI: You’ll find the study, which was published as a research letter, on the JAMA Internal Medicine website, although the full study is behind a paywall.