COVID-19 News: Social Inequities in COVID deaths; COVID-related Delays in Medical Care

By Center for Infectious Disease Research and Policy

Study suggests nonwhite, poor, less educated at high risk for COVID death

Nonwhite Americans, those with low incomes or less than a high school education, and veterans were much more likely to die of COVID-19 than others in a simulation study published yesterday in PLOS Medicine, backing the findings of previous research.

Harvard University researchers used data from the 2017-18 National Health and Nutrition Examination Survey (NHANES) and deaths reported by public health agencies in the United States, China, the United Kingdom, Spain, Italy, and France to simulate COVID-19 deaths among community-dwelling US adults 20 years and older in spring and summer 2020.

Those who died of COVID-19 were, on average, 71.6 years old, 45.9% were female, and 45.1% were white. Disproportionate deaths occurred among participants of nonwhite race (54.8%), those with incomes below the national median of $55,000 to $64,999 (67.5%), those with less than a high school education (25.6%), and veterans (19.5%; they make up only 9% of the US population).

The ties between social determinants of health and COVID-19 death are comparable in scale to those between high blood pressure, diabetes, and coronavirus death, according to the authors.

The researchers noted that their study included only community-dwelling participants, included data on underlying illnesses collected outside the United States, assumed the same correlations in variables for both community-dwelling and institutionalized COVID-19 decedents, and did not include other possible social contributors to health inequities.

“As the simulation only considers age, gender, race/ethnicity, and comorbidity as drivers of death, direct effects of social determinants of health on vulnerability to infection and mortality are not explicitly modeled,” the authors wrote. “These effects include crowded living conditions, limited access to care, and economic hardship that may force people to continue to risk exposure by working.” 

The researchers called for systematic collection of information on social determinants of health from COVID-19 patients and prioritization of public health measures to groups overrepresented in coronavirus deaths. 
Jan 11 PLOS Med study

Americans say they delay medical care when COVID-19 rates are high

A national survey by the Orlando Health Heart & Vascular Institute (OHHVI) finds many Americans would choose to delay doctor’s appointments and even emergency care when COVID-19 rates are high in their communities.

About 67% of respondents said they were concerned about going to medical appointments when COVID-19 rates are high in their community, and 57% said they were hesitant to go to the hospital—even in an emergency.

Also, 49% of respondents said they will not reschedule missed in-person medical appointments until COVID-19 concerns are reduced in their area, and the same percent said they worry their health will suffer because of in-person appointments missed due to COVID-19.

The survey was conducted online by the Harris Poll on behalf of Orlando Health from Dec 4 through Dec 7, 2020, and involved 2,043 US adults.

“Because of the extensive protocols in place, COVID-19 transmissions in hospitals are very rare,” said Joel Garcia, MD an interventional cardiologist at the OHHVI, in an Orlando Health news release. “There is more risk in not paying attention to symptoms or medical conditions than the benefit of staying home thinking you will not get exposed to COVID-19.”

“I understand their hesitation. But there’s no question, across diagnoses, whether for chronic or acute conditions, the later in the disease process that we see people and can intervene, the worse their outcomes.” said Steven Hoff, MD, an OHHVI cardio thoracic surgeon.
Jan 12 Orlando Health press release

Source: Center for Infectious Disease Research and Policy

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