Latinx patients tested positive for the novel coronavirus at nearly double the rate their black and white peers did, according to new research out of Johns Hopkins University, underscoring the deepening racial health disparities observed throughout the entire pandemic.
More specifically, of the nearly 6,000 patients who tested positive for COVID-19 between March and May, 42.6 percent identified as Latinx, while 17.6 percent were black, 17.2 identified as other, and 8.8 percent were white.
These trends are not necessarily new, but they are stark and alarming, the researchers said. The coronavirus pandemic has put racial health disparities under the microscope, with public health officials calling for COVID-19 testing and outcomes data stratified by race as early as April, and analyses coming in confirming disparities by race ever since.
On the whole, national data sets have shown racial health disparities that have adversely and disproportionately affected black patients.
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Experts have agreed that these disparities did not arise because black patients are predisposed to the novel coronavirus; instead, decades of institutional racism has limited patient access to care and driven the social determinants of health, yielding higher rates of chronic illness that can subsequently exacerbate COVID-19.
This latest assessment adds to that literature, revealing that racial health disparities are also affecting Latinx populations. The researchers looked at COVID-19 test results for 37,727 patients presenting in five Johns Hopkins Medicine facilities between March 11 and May 25.
Of those patients, 6,162 tested positive for the virus, but those positive results disproportionately affected individuals identifying as Latinx. Nearly double the amount of Latinx patients tested positive for COVID-19 compared to their black and white peers.
The researchers suggested that social determinants of health, specifically those tied to housing and employment, could be the driver for the peak in Latinx patients. Crowded living situations and essential worker status may have led more Latinx patients to be exposed to the virus, hence the spike in cases.
“Many of these patients tell me they delayed coming to the hospital until absolutely necessary because they were worried about medical bills, and were not sure if they could receive care because of their immigration status,” Kathleen R. Page, MD, an associate professor of medicine at Johns Hopkins School of Medicine, said in a statement.
“Most of the patients I’ve met are not eligible for benefits, have no health insurance, and rent rooms in crowded houses,” Page, who also cared for many infected patients, added. “The need to work, lack of occupational protections and crowded living conditions have led to high transmission in this community.”
Although the study did not report death rates or outcomes as stratified by race, it did outline some metrics suggesting Latinx patients are facing health disparities because they are more likely to experience community spread, not necessarily because of existing health factors, although comorbidities are always at play.
For example, Latinx patients were less likely to be hospitalized than their black and white peers. About 29 percent of Latinx patients were admitted into the hospital for COVID-19 symptoms, while 41.7 percent of black patients and 40.1 percent of white patients were.
However, of the Latinx patients who were admitted to the hospital, far more of them were younger and were less likely to have a chronic illness, negating the narrative that older individuals with comorbidities tend to suffer from COVID-19 symptoms more often. These findings, too, may suggest Latinx patients are more susceptible to community spread.
Nonetheless, Page and colleagues contended that limited access to care and other systemic health equity issues have given rise to this racial health disparity.
“It is clear that the systematic exclusion of this population from health care services has contributed to the disparities we see today,” Page asserted. “This pandemic has taught us that we are all interconnected. At the very least, we must engage with communities early and provide language and culturally appropriate information and services, removing as many barriers to care as possible.”
These findings only look at one subset of the larger, national Latinx population, the researchers acknowledged. That said, this latest report did test a large, diverse community that may be representative of the nation at large. Understanding this kind of data is the first step to creating policies to address health equity and protect traditionally marginalized populations.
“Knowing what is driving these health disparities in each region is much-needed evidence to develop tailored policies and interventions to better serve all of our people,” explained Diego A. Martinez, PhD, assistant professor of emergency medicine at the Johns Hopkins University School of Medicine, and one of the study report’s authors.
“Protecting Latinx individuals, building trust and reducing barriers to engagement in public health initiatives, such as providing equal protection for workers; reducing the threat of deportation; and performing charity care for those unable to afford health care and, should be essential as our nation grapples with strategies to contain the impact of COVID-19,” Martinez added.
It’s these very health disparities that led the Centers for Medicare & Medicaid Services to double down on its calls for more value-based care. In its own analysis of COVID-19 cases among Medicare beneficiaries between January 1 and May 16, CMS observed black patients being hospitalized for COVID-19 at a rate four times that of white patients.
Hispanic patients had a hospitalization rate of 258 per 100,000 patients, compared to 187 per 100,000 Asian patients and 123 per 100,000 white patients.
These disparities must be combatted by addressing patient wellness, not by providing sick care, CMS said. To that end, the industry needs to continue its shift toward value-based care, which reimburses providers on the basis of keeping patients healthy, controlling chronic illness, and addressing population health.
“The disparities in the data reflect longstanding challenges facing minority communities and low income older adults, many of whom face structural challenges to their health that go far beyond what is traditionally considered ‘medical’,” CMS Administrator Seema Verma said in a statement.
“Now more than ever, it is clear that our fee-for-service system is insufficient for the most vulnerable Americans because it limits payment to what goes on inside a doctor’s office. The transition to a value-based system has never been so urgent. When implemented effectively, it encourages clinicians to care for the whole person and address the social risk factors that are so critical for our beneficiaries’ quality of life.”
Source: PatientEngagement HIT