Bronx hit hardest in NYC as vast gaps seen in coronavirus hospitalization and death rates across city boroughs
There are huge disparities in coronavirus hospitalization and death rates across New York City boroughs, the epicenter of the US's COVID-19 pandemic, find experts.
New York City is composed of five boroughs - the Bronx, Brooklyn, Manhattan, Queens, and Staten Island - each with unique demographic, socioeconomic, and community characteristics. Understanding the patterns could inform public health and policy strategies to mitigate the ongoing spread of COVID-19, and future approaches to address a possible resurgence of the coronavirus disease, say, researchers. Their analysis shows that substantial differences in COVID-19-related hospitalizations and deaths have emerged along racial and socioeconomic lines in New York City.
According to the research team, the Bronx - the borough with the highest proportion of racial and ethnic minorities, the most persons living in poverty, and lowest levels of educational attainment - had higher rates of hospitalization and death related to COVID-19 than all other boroughs. In contrast, hospitalization and death rates were lowest in Manhattan, the most affluent borough, which is comprised of a predominately white population. The number of COVID-19 deaths per 100,000 persons was nearly two times greater in the Bronx than in Manhattan, say researchers.
The team includes experts from Beth Israel Deaconess Medical Center (BIDMC), Boston; NYU Langone Medical Center, New York; New York-Presbyterian/Columbia University Medical Center; Harvard T.H. Chan School of Public Health, Boston, and Washington University School of Medicine in St Louis.
“The substantial variation in the rates for COVID-19 hospitalizations and deaths across the New York City boroughs is concerning. The Bronx, which has the highest proportion of racial/ethnic minorities, the most persons living in poverty, and the lowest levels of educational attainment had higher rates of hospitalization and death related to COVID-19 than the other four boroughs,” say researchers in their findings published in JAMA.
And the Bronx is not just the poorest borough in the city, it is the unhealthiest. “Despite all the campaigns to end the Bronx’s ranking as New York State’s unhealthiest county, our borough came in dead last once again. What’s worse is the glaring disparity when just across the river, Manhattan is one of the healthiest in the state and the average life expectancy is higher at 84.5 compared to the Bronx where it is only 80.4,” says an analysis.
According to the researchers of the current study, as of April 25, 2020, over 150,000 cases had been reported in New York City, which is approximately 17% of total cases in the US. The team looked at population characteristics (for example, race/ethnicity), socioeconomic characteristics (median household income, poverty, education), and hospital bed capacity across the five boroughs. They then evaluated rates per 100,000 people of COVID-19 testing, COVID-19 patient hospitalizations, and COVID-19-related deaths according to patients' borough of residence based on data from the NYC Health Department.
“The total population of New York City was 8,398,748. Across the 5 boroughs, the population density ranged from 8,112 per square mile in Staten Island to 71,434 per square mile in Manhattan. The proportion of older adults (aged ≥65 years) was lowest in the Bronx (12.8%) and highest in Manhattan (16.5%), whereas the proportion of black or African American persons was highest in the Bronx (38.3%) and lowest in Staten Island (11.5%),” says the study.
According to the analysis, household median income was lowest in the Bronx ($38 467) as was the proportion of persons with a bachelor’s degree or higher (20.7%). There were 48 short-term acute care hospitals. The number of hospitals per borough ranged from two in Staten Island to 16 in Manhattan. The number of hospital beds per 100,000 population was lowest in Queens (144 beds) and highest in the Bronx (336 beds) and Manhattan (534 beds).
The findings show that among New York City boroughs, there was variation in the number of COVID-19 tests performed per 100,000 population -- 4,599 in the Bronx, 2,970 in Brooklyn, 2,844 in Manhattan, 3,800 in Queens, and 5603 in Staten Island. The number of patients with COVID-19 who were hospitalized per 100,000 population was highest in the Bronx (634) and lowest in Manhattan (331). The numbers were 404 in Brooklyn, 331 in Manhattan, 568 in Queens, and 373 in Staten Island. The number of deaths related to COVID-19 per 100,000 population was also highest in the Bronx (224) and the lowest in Manhattan (122). The total number of deaths for the others were 181 in Brooklyn, 200 in Queens, and 143 in Staten Island.
“Manhattan and the Bronx have the highest number of per capita hospital beds, and Manhattan has the highest population density, indicating that other factors, such as underlying comorbid illnesses, occupational exposures, socioeconomic determinants, and race-based structural inequities may explain the disparate outcomes among the boroughs,” says the team. The experts say it is important to understand the extent to which these factors explain the disparate outcomes among boroughs to help shape ongoing public health strategies and policies that aim to mitigate and contain COVID-19.
Race and income shape COVID-19 risk
According to the US Centers for Disease Control and Prevention, the effects of COVID-19 on the health of racial and ethnic minority groups are still emerging. However, current data suggest a disproportionate burden of illness and death among racial and ethnic minority groups, says CDC.
A recent CDC report that included race and ethnicity data from 580 patients hospitalized with lab-confirmed COVID-19 found that 45% of individuals for whom race or ethnicity data was available were white, compared to 55% of individuals in the surrounding community. However, 33% of hospitalized patients were black compared to 18% in the community and 8% were Hispanic, compared to 14% in the community. These data suggest an overrepresentation of blacks among hospitalized patients, say experts.
Among COVID-19 deaths for which race and ethnicity data were available, New York City identified death rates among black/African American persons (92.3 deaths per 100,000 population) and Hispanic/Latino persons (74.3), which were substantially higher than that of white (45.2) or Asian (34.5) persons. Studies are underway to confirm these data and understand and potentially reduce the impact of COVID-19 on the health of racial and ethnic minorities.
Experts say that health differences between racial and ethnic groups are often due to economic and social conditions that are more common among some racial and ethnic minorities than whites. In public health emergencies, these conditions can also isolate people from the resources they need to prepare for and respond to outbreaks. Existing health disparities, such as poorer underlying health and barriers to getting health care, might make members of many racial and ethnic minority groups especially vulnerable in public health emergencies like outbreaks of COVID-19, says the CDC.
According to a recent study by the Boston University School of Public Health (BUSPH), underlying conditions that increase the risk of severe illness or death from COVID-19 are much more common among black, Native American, and lower-income people in the US. The researchers say the new coronavirus does not discriminate, but discrimination and inequality have shaped the risk of severe illness and death.
The team found that black, Native American, and lower-income people are much more likely to have one or more of the risk factors for severe or deadly COVID-19 illness identified by the CDC, such as asthma, diabetes, or being pregnant or over 65 years old. They used 2018 data on over 330,000 people from the nationally-representative Behavioral Risk Factor Surveillance System and looked at the prevalence of the COVID-19 risk factors. They estimated that 43% of American adults -- approximately 97 million people -- have at least one risk factor, and 18% or approximately 40 million people, have two or more.
Among those under 65 years old, 33% of black and 42% of Native American adults had at least one risk factor, compared to 27% of white adults. Further, 11% of black and 18% of Native American respondents had multiple risk factors, compared to 8% of white respondents. For those 65 years old or older, 69% of Native Americans and 61% of black respondents had one or more additional risk factors beyond age, compared to 54% of white respondents, shows analysis.
“At least 25 million people living in low-income households have at least one risk factor. Among those under 65 years old, low-income respondents were almost twice as likely to have one or more risk factors than high-income respondents, and more than twice as likely to have multiple risk factors. Low-income respondents over 65 years old were also more likely to have multiple risk factors beyond age,” says the study published in the American Journal of Preventive Medicine.
According to the researchers, the inequities that contribute to chronic conditions also make these populations more likely to work in jobs that cannot be done remotely, and to live in crowded, multi-generational homes, increasing their risk of exposure to the coronavirus.
“People who are black, American Indian, or lower-income are both more likely to be exposed to COVID-19 and more likely to develop severe illness if they contract the virus. As society considers return-to-work policies and recovery efforts, it's important to recognize that risk of exposure and the severity of COVID-19 is not uniform across America. There's a real risk that the rising tide of recovery will not lift all boats equally. And, worse, that it might further exacerbate disparities in health for minorities and the least affluent among us,” say researchers in the analysis.
As of May 2, over 1,103,460 coronavirus cases have been reported from across the US, and 64,943 have died in the COVID-19 pandemic, shows the Johns Hopkins tracker.