Covid-19 deadlier for people of color across Texas and US which struggle with disproportionate death toll

Non-White counties in US had higher cumulative incidences and deaths compared to predominantly White counties, and this was true for both low-income and high-income communities, shows an analysis


                            Covid-19 deadlier for people of color across Texas and US which struggle with disproportionate death toll
(Getty Images)

People of color across Texas and the US bear a larger share of the Covid-19 burden, shows multiple studies. According to a new counting method by the Texas Department of State and Health Services (DSHS) — where it began using death certificates to identify Covid-19 fatalities — Hispanic Texans comprise nearly 40% of the state's population but account for 48.8% of the coronavirus fatalities. Black Texans are also overrepresented: they account for 13.8% of fatalities but just 11.9% of the state population. In contrast, White Texans make up for 41.4% of the state’s population and account for 34% of Covid-19 deaths.

Previously, the DSHS had counted coronavirus fatalities as they were reported publicly by local and regional health departments after they received a notification and verified the death. Overall, 6,274 Texans have died in the Covid-19 pandemic and 412,107 cases have been reported from across the state as of July 30.

According to the Texas Tribune, Cameron, the southernmost county that is home to 1.5% of the state’s population, accounts for nearly 5% of its known Covid-19 deaths. In comparison, Harris county, which has 16.4% of the state’s population, accounts for 19.2% of the deaths so far. "Cameron County — where 89% of residents are Hispanic and nearly a third live below the poverty line — stands out as just one stark example of widespread disparities in Covid-19 outcomes. Across Texas and the nation, the novel coronavirus is deadlier for communities of color and low-income communities," says the report. 

The ongoing Color of Coronavirus project by APM research lab shows that in Texas, the Covid-19 death rate for Black Americans is 24 per 100,000 as compared to 7 per 100,000 among White Americans, till July 21. 

Hispanic Texans comprise nearly 40% of the state’s population but account for 48.8% of the coronavirus fatalities (Getty Images)

Disparities evident across the US

While data and news reports show that Black and Hispanic communities are disproportionately affected by the pandemic, the role that neighborhood income plays in Covid-19 deaths is less clear.  Now research by the NYU Grossman School of Medicine shows that non-White counties had higher cumulative incidences and deaths compared to predominantly White counties, and this was true for both low-income and high-income communities. As of July 31, over 17,238,830 coronavirus cases have been reported from across the US, and more than 671,980 have died in the Covid-19 pandemic. 

The team examined the interplay between race/ethnicity and income on Covid-19 cases and related deaths. They analyzed coronavirus cases and deaths per 100,000 across 158 urban counties (accounting for 64% of confirmed Covid-19 cases) spanning 10 large US cities: New York City, Boston, New Orleans, Detroit, Los Angeles, Atlanta, Miami, Chicago, Philadelphia and Seattle. The findings, published in JAMA Network Open, suggest that racial disparities in Covid-19 cases and deaths exist beyond what can be explained by differences in poverty rates.

Researchers found that even among communities with higher median income, predominantly non-White communities still bore a greater burden of the virus — almost three times the incidence and deaths — compared to neighborhoods that identified as majority White. "While we expected to see greater numbers of Covid-19 cases and deaths in predominantly non-White, low-income communities, we were surprised that this relationship still held even after we accounted for poverty rates. Given our findings, we believe that structural racism may explain these racial disparities in the number of cases and deaths noted in Black counties," writes lead author Dr Samrachana Adhikari, assistant professor at NYU Grossman School of Medicine.

Yet income also plays an important contributing role. The starkest racial or ethnic contrast between majority non-White and predominantly White counties was found when restricted to low-income counties only. The analysis shows that in poorer counties, residents from predominantly non-White communities died from Covid-19 at nine times the rate as those living in predominantly White counties. In poorer counties, those with predominantly non-white residents had an infection rate nearly eight times that of counties with substantially White populations.

"The fact that non-White residents died from the virus at higher rates than White residents in both wealthier and poorer communities should be a major alarm bell to policymakers at the national and local government levels, academic medical centers and the country at large,” says one of the study authors Gbenga Ogedegbe, MD, a professor of population health and medicine at NYU Langone.

In poorer counties, residents from predominantly non-White communities died from Covid-19 at nine times the rate as those living in predominantly White counties, says a study (Getty Images)

In another study, researchers at Harvard University compared the distribution of coronavirus deaths by race with data from the National Center for Health Statistics weighted population and the US Census unweighted population. Both data sets were provided by the US Centers for Disease Control and Prevention (CDC). 
In total, 54,861 Covid-19 deaths were reported as of May 13, 2020.

Applying the US Census population distribution, Black individuals were the most overrepresented among Covid-19 deaths, accounting for 9.9% greater than their share of the US Census population, whereas White individuals were underrepresented (−8.1%). In contrast, comparisons with the weighted data suggest that White individuals are most overrepresented among Covid-19 deaths (10.9%) Discrepancies were also noted when comparing deaths with the unweighted versus weighted populations among Latinos (−1.7% versus −10.2%) and Asian (0.1% versus −5.7%) individuals.

Researchers concluded that the CDC's current weighted reporting of Covid-19 deaths by race/ethnicity inaccurately depicts the impact of coronavirus on people of color. Instead, the CDC should report mortality rates by race/ethnicity that are further stratified by age, gender, zip code and other population data factors.

"The CDC's weighting approach inflates the proportion of residents of color in the weighted population (for example, where the state's true population is 30% people of color, but the CDC's weighted population is 46.7% people of color. In New York, for instance, large urban counties with higher percentages of crowded households and residents of color are weighted more heavily compared with their share of the population than smaller, suburban, and rural counties, where residents are predominantly White," says the study published in JAMA Network Open.

"In summary, the CDC's presentation of data on race/ethnicity and Covid-19 deaths is misleading, with consequences for resource allocation for mitigating health inequities. We urge the CDC to drop the misleading weighted counts and publish mortality rates per race/ethnicity group stratified by age, gender, education and ZIP code characteristics to adequately equip epidemiologists and policymakers with the data to mitigate inequities," the authors recommend.

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