Disparities in vulnerability to complications from COVID-19 arising from disparities in preexisting conditions in the United States

Abstract

The COVID-19 pandemic has magnified U.S. health disparities. Though disparities in COVID-19 hospitalization by race-ethnicity are large, disparities by income and education have not been studied. Using an index based on preexisting health conditions and age, we estimate disparities in vulnerability to hospitalization from COVID-19 by income, education, and race-ethnicity for U.S. adults. The index uses estimates of health condition and age effects on hospitalization for respiratory distress prior to the pandemic validated on COVID-19 hospitalizations. We find vulnerability arising from preexisting conditions is nearly three times higher for bottom versus top income quartile adults and 60 % higher for those with a high-school degree relative to a college degree. Though non-Hispanic Blacks are more vulnerable than non-Hispanic Whites at comparable ages, among all adults the groups are equally vulnerable because non-Hispanic Blacks are younger. Hispanics are the least vulnerable. Results suggest that income and education disparities in hospitalization are likely large and should be examined directly to further understand the unequal impact of the pandemic.

Reductions in 2020 US life expectancy due to COVID-19 and the disproportionate impact on the Black and Latino populations

“…The risk of COVID-19 mortality is also heightened by several chronic conditions that are prevalent at older ages, such as hypertension, obesity, diabetes, cancer, and heart disease (32–34). Black adults generally have higher rates of these co-morbidities, as well as higher death rates from these conditions, than whites or Latinos, often developing these conditions at much younger ages (33, 35–37). In contrast, Latinos report lower rates of cancer and heart disease (33, 38) compared with both white and Black adults, although they experience relatively high rates of both obesity and diabetes (33, 35, 36, 38).…”

Rectifying COVID-19 disparities with treatment and vaccination

“…Death from COVID-19 varies by US county, with fewer deaths in counties populated by those who are college educated, hold medical insurance, and have higher incomes, as compared with counties with more diverse populations that are associated with poor grocery mobility (food deserts), poor work mobility (e.g., need for public transportation), and higher SARS-CoV-2 infection rates ( 17 ). Health comorbidities are more prevalent in specific diverse populations, thus increasing the risk for severe COVID-19 ( 18 ). By the age of 65 years, 40% of the African American population demonstrates 3 or more comorbid risk factors, compared with 29% of White and 28% of Latin American populations ( 18 ).…”

“…Health comorbidities are more prevalent in specific diverse populations, thus increasing the risk for severe COVID-19 ( 18 ). By the age of 65 years, 40% of the African American population demonstrates 3 or more comorbid risk factors, compared with 29% of White and 28% of Latin American populations ( 18 ). Even between the ages 45 and 64 years, 23% of the African American population shows 3 or more comorbid risk factors, compared with 13% of White and 11% of Latin American populations ( 18 ).…”

“…By the age of 65 years, 40% of the African American population demonstrates 3 or more comorbid risk factors, compared with 29% of White and 28% of Latin American populations ( 18 ). Even between the ages 45 and 64 years, 23% of the African American population shows 3 or more comorbid risk factors, compared with 13% of White and 11% of Latin American populations ( 18 ). The increased frequency of comorbidities is a consequence of socioeconomic inequality.…”

Psychosocial Risk Factors, Noncommunicable Diseases, and Animal Models for COVID-19

“…Overall, emergence of diseases exacerbating the Covid-19 prognosis appears highly sensitive to psychosocial risk factors. In particular, psychosocial stress mediates much of the link between low SES and high prevalence of NCDs ( 7 , 15 ); commensurate with that, NCDs and life-threatening COVID-19 outcomes disproportionately impact low SES communities and disadvantaged minorities ( 5 , 16 ).…”