New review confirms disproportionate impact of COVID-19 on Black, Hispanic populations

The disparities were likely related to minority populations being at higher risk of exposure to the coronavirus as opposed to underlying health conditions or other factors, according to the review led by researchers at Oregon Health & Science University and the VA Portland Health Care System.

The review confirms health disparities that have been widely reported in a series of observational studies nationwide.

"It's likely rooted in social determinants of health and longstanding inequalities in terms of housing, transportation, occupation and access to health care," said lead author Katherine Mackey, M.D., a staff physician in the Department of Hospital and Specialty Medicine at the Portland VA and assistant professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine.

The review published this week in the Annals of Internal Medicine.

Funded and conducted at the behest of the U.S. Department of Veterans Affairs, the study closely examined 52 observational studies conducted since the beginning of the year.

"This is the first paper to comprehensively examine the literature about COVID-related health disparities and the factors leading to disparities in health outcomes," said senior author Devan Kansagara, M.D., a staff physician in the Department of Hospital and Specialty Medicine with the Portland VA and an associate professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine. "The information we've seen so far suggests the disparities were likely related to exposure-related factors rather than other factors, like underlying health issues."

Kansagara added that he expects further clarity as evidence continues to build over the course of the pandemic.

The review highlights the fact that racial and ethnic minority populations are disproportionately harmed by the virus primarily because they are at heightened risk of being exposed in the first place. Underlying health conditions did not appear to be a factor driving higher rates hospitalizations and deaths.

Instead, the evidence suggests disparities in housing, transportation and occupations are likely raising the risk of exposure and transmission of the virus. In Oregon, for example, several outbreaks have affected workers in food processing and agriculture, with a labor pool comprised to a large degree by Latino workers. Some efforts are underway to reduce the risk of exposure, including a longtime health outreach program operated by OHSU Health Hillsboro Medical Center.

"We need to double down on efforts to reduce exposure to the virus in the first place among vulnerable populations," Kansagara said.

The systemic review was funded by the U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development, VA ESP Project No. 09-199; 2020.