BY DR. RHONDA M. MEDOWS, president of population health management, Providence St. Joseph Health
May 5, 2020
The tragic mortality rates the United States is experiencing during the COVID-19 pandemic have amplified health disparities, and the heavier burden is borne by the people of color in this country. My own family members suffered from the more severe consequences of this viral illness. Our losses are very real, and much more than any statistic can describe. As a society, we must start better identifying the root of health disparities and work together to develop real solutions.
At Providence, we have analyzed our own initial patient population data across multiple western states who were served by our health system. Our total patient sample size for minority populations is small compared to other states but still relevant. We asked ourselves as a society and health professionals, how could we have done more prevention outreach and more testing? Did we assess and treat everyone to the best of our ability and is there more we can do now — not just during COVID-19 but to improve health outcomes overall?
Here's what our initial observations show:
- The COVID-19 testing rate for African Americans was higher than the general population but significantly lower than the rate for Hispanics.
- The percentage of African Americans and Hispanics with positive COVID-19 tests is higher than our general patient population however hospitalization rates are lower in both groups.
- Where we differ from our east coast colleagues is that mortality rates within our small African American population is on par with the general population. Mortality rates for Hispanics are lower than the general population.
- Diabetes is the most consistent chronic condition associated with increased mortality.
- An additional observation that needs more research is that when deaths do occur in these groups, more occur in the emergency room versus hospital inpatient.
- We also note men are almost twice as likely as women to die of COVID-19.
- When looking at employment status and insurance coverage, we clearly see and confirm the people most commonly impacted are the disabled, the retired, and people on Medicare or dually eligible for Medicaid and Medicare.
These preliminary observations are important because it shows us that there are health disparities and inequities in care across our country. This fact is absolutely unacceptable. Much has been said about the multitude of contributing causes of racial and ethnic disparities in health as well as the social and economic determinants impacting health, but these inequities still persist today. These disparities are compounded by an ongoing cultural bias — both intentional and not, which exist regardless of a patient's social, economic, and educational status.
The early observation regarding people of color dying in the emergency room is an important observation and requires more research. Did they come into receiving care late or was their care delayed?
Every race has members of different socioeconomic status, yet black Americans in particular are being impacted at a higher rate during this COVID pandemic. This begs the question of why? As a physician and a leader in the work of social determinates of health, I look at questions like this daily.
To some, this may seem like an unfortunate situation that some patients experience, especially while navigating the COVID-19 pandemic. However, to me and to so many others, it is so much more.