New research from the Federal Reserve Bank of New York shows that underlying medical conditions, a lack of health insurance and population density — including how many people live together in a household and crowding on public transit — are three factors that significantly exacerbate the intensity of Covid-19 rates among minority and low-income communities.
Racial health disparities already existed in the U.S., but the Covid-19 pandemic heightened them. Although patient information on race and ethnicity isn't always reported, Black Americans have died at 1.6 times the rate of their White counterparts nationwide, according to an analysis from the COVID Tracking Project.
The Centers for Disease Control and Prevention finds that within the 77% of Covid-19 deaths where race was reported, Black Americans made up about 16.4%. However, they only make up about 13.4% of the U.S. population, according to U.S. Census Bureau estimates.
Similarly, about 4% of Covid deaths have been from Americans identifying as two or more races even though only 2.8% of the U.S. falls into this racial group. Covid deaths among Hispanic and White Americans, however, are lower than or on par for their proportion of the U.S. population at the moment.
Researchers looked at a number of factors to determine what could contribute to the higher proportion of cases and deaths among minority and low-income Americans, including health conditions, access to ICU hospital beds, health insurance rates, home crowding, public transit use, pollution, age and employment in essential services.
It makes sense that health care, particularly access to insurance, and living arrangements play a role. "Having health insurance ensures greater access to health resources; it creates a more robust relationship between the individual and the health-care system," says Maxim Pinkovskiy, a senior economist in the bank's research and statistics group. "It encourages people when there's a health problem to actually seek care rather than worry about how much it may cost down the road."
Using multivariate regression analysis, the researchers found that by controlling for medical conditions, insurance rates and population density, the income-based gap in the Covid-19 case rate is reduced by 42% and the racial gap by 60%. In other words, these three factors contribute in big ways to the spread of Covid-19 among these groups of Americans.
That said, the analysis shows only a correlation, not a causation, says senior bank economist and researcher Rajashri Chakrabarti. Additionally, the minority and income-based gaps are not completely wiped out when those three factors are taken into account. "There is an unexplained portion of Covid-19 incidence that remains associated with both income and race," the study's authors write.
"There are multiple factors that matter," says Pinkovskiy. While it may be difficult to solve for underlying health issues since heredity and environment play a role, there are policy changes regarding health insurance and crowding, particularly on public transit, that could be implemented in order to reduce the disparities of Covid-19, researchers say.
For example, lawmakers could consider expanding health insurance options since 43.4% of U.S. adults ages 19 to 64 were inadequately insured during the first half of 2020, according to the Commonwealth Fund. Another option would be for civic leaders to deploy more resources to reduce passenger density on buses, subways and trains. "We think these correlations are useful for deciding where to allocate the policy attention and tracking to come next," Pinkovskiy says.
"Policy can play a pretty big role in alleviating some of this gap," Chakrabarti adds.