Health Policy Journal Club, Health Policy, Advocacy, COVID-19

Health Policy Journal Club: Drivers of Disparities in COVID-19

Large increases in Covid-19 case counts occur in areas with bigger minority populations

The COVID-19 pandemic has affected the entire country, but early data suggest its effects have been particularly devastating on Black and Latino communities. For many people in health care fields, this is sadly unsurprising; there are few diseases whose impacts remain untouched by systemic racism. Many causes for the disparities in COVID-19 outcomes have been postulated, but thus far the specific contributing factors remain poorly understood.

This study investigated the outbreak in Massachussetts, among the hardest hit states early in the pandemic. Drawing on data from the Massachusetts Department of Public Health, investigators performed a cross-sectional analysis of 351 towns and cities across the state. They compared the rates of COVID-19 cases based on each town's demographics, as well as several factors thought to be potential causes of racial and ethnic disparities.

The authors found that for each 10% increase in a town's Black and Latino population there was an associated 3123 per 100,000 and 2582 per 100,000 increase in COVID-19 cases, respectively. Proportions of foreign-born non-citizens, average household size, and share of food service workers all independently predicted COVID-19 case rates. Controlling for these variables attenuated the relationship between Latino population and COVID cases, suggesting that these may be significant causes of the disparities seen in Latino communities. However, the relationship between Black population and COVID cases was not affected by these variables, suggesting that other factors may be causing the disparity. The authors postulate that increased use of public transportation, housing segregation, and other structural inequities may contribute.

Racial and ethnic disparities plague America's health care system at almost every level with the COVID-19 pandemic throwing these effects into stark relief. While proportions of foreign-born non-citizens, average household size, and share of food service workers may effectively explain the disparities among Latino communities additional research is needed to identify the causes among Black communities. A strong, effective, and just public health response must be aware of both racial disparities and their causes in order to combat them. This research shows that any attempt to tackle the pandemic, from social distancing strategies to contact tracing to vaccine distribution, must also grapple with systemic inequities in health care.

Abstract: Figueroa JF, Wadhera RK, Lee D, Yeh RW, Sommers BD. Community-Level Factors Associated with Racial and Ethnic Disparities in COVID-19 Rates in Massachusetts. Health Aff (Millwood). 2020;39(11):1984-1992.

Massachusetts has one of the highest cumulative incidence rates of coronavirus disease 2019 (COVID-19) cases in the U.S. Understanding which specific demographic, economic, and occupational factors have contributed to disparities in COVID-19 incidence rates across the state is critical to informing public health strategies. We performed a cross-sectional study of 351 Massachusetts cities and towns from January 1 to May 6, 2020, and found that a 10-percentage-point increase in the Black non-Latino population was associated with an increase of 3123 COVID-19 cases per 100,000 population, whereas a 10-percentage-point increase in the Latino population was associated with an increase of 2582 cases per 100,000.

Independent predictors of higher COVID-19 rates included:
• Proportion of foreign-born noncitizens living in a community
• Mean household size
• Share of food service workers

After adjustment for these variables, the association between the Latino population and COVID-19 rates was attenuated. In contrast, the association between the Black population and COVID-19 rates persisted but may be explained by other systemic inequities.

Conclusion: Public health and policy efforts that improve care for foreign-born noncitizens, address crowded housing, and protect food service workers may help mitigate the spread of COVID-19 among minority communities.

PMID: 32853056

EMRA + PolicyRx Health Policy Journal Club: A collaboration between Policy Prescriptions and EMRA

As emergency physicians, we care for all members of society, and as such have a unique vantage point on the state of health care. What we find frustrating in our EDs - such as inadequate social services, the dearth of primary care providers, and the lack of mental health services - are universal problems. As EM residents and fellows,  we learn the management of myocardial infarctions and traumas, and how to intubate, but we are not taught how health policy affects all aspects of our experience in the ED. Furthermore, given our unique position in the health care system, we have an incredible opportunity to advocate for our patients, for society, and for physicians. Yet, with so many competing interests vying for our conference education time, advocacy is often not included in the curricula. This is the gap this initiative aims to fill.  Each month, you will see a review of a new health policy article and how it is applicable to emergency physicians.