BLOOMINGTON, Ind. – Black and Hispanic Americans suffered greater COVID-19 health burdens than their white peers during the COVID-19 pandemic due to disadvantage in social determinants, medical determinants, and longstanding institutional features of systemic racism, according to a new study co-authored by Indiana University O’Neill School of Public and Environmental Affairs Professor Kosali Simon, along with Harvard Kennedy School Professors Marcella Alsan and Amitabh Chandra.
The study, “The Great Unequalizer: Initial Health Effects of COVID-19 in the United States,” was released today as part of the National Bureau of Economic Research’s Working Paper Series.
Alsan is a medical doctor, a public health scholar, and a microeconomist studying health inequality. Chandra, the Ethel Zimmerman Wiener Professor of Public Policy, is director of health policy research at the Kennedy School and also teaches at Harvard Business School. Simon is a Herman B Wells Endowed Professor and Associate Vice Provost for Health Sciences at Indiana University Bloomington.
The trio examined inequality in the effect of COVID-19 on the health of different population groups, using a database of commercial and Medicare Advantage claims. The researchers used data from all enrollees who were hospitalized for COVID-19 during the first three quarters of 2020, and compared with a five percent random sample of those not hospitalized for COVID-19. The final sample included approximately 322,000 non-Hispanic white Americans; 50,000 non-Hispanic Black Americans, and 61,000 Hispanic Americans.
“When COVID-19 first appeared, many believed the virus was an equal opportunity pathogen—no one was immune, and anyone could be affected,” Simon said. “But the virus exposed societal gaps between the less privileged and more advantaged groups.”
Simon and her colleagues discovered that the elderly, Hispanic, Black, and Native American communities were all disproportionately affected by the virus, particularly when using an innovative metric that measures the life loss potential.
“We found that Hispanic Americans saw a 39.5 percent rise in excess mortality, and Black Americans a 25 percent increase when compared to whites, who had a 15 percent rise in excess mortality rates in 2020,” Simon said.
Other findings from the report include:
- There were significantly higher hospitalization rates for Black and Hispanic Americans due to COVID-19, even though the populations had fairly equitable insurance statuses in the data they analyzed.
- Black, American Indian, and Hispanic individuals died almost always at greater rates from COVID-19 and they died at younger ages. Excess mortality in younger age groups was substantially higher than in older groups, “indicating that the already high number of Black and Hispanic pandemic-related deaths disproportionately occurred among the young,” according to the study.
- Not only did Black and Hispanic Americans die at greater rates during the pandemic, those who died had, on average, many more years of life left to live. Losses in potential years of life were three to four times larger among Hispanic and Blacks Americans compared to whites.
- Black and Hispanic Americans tend to have a greater number of comorbidities that heighten the risk of severe COVID-19.
- However, the stark differences in COVID-19 health outcomes for Black and Hispanic Americans compared to non-Hispanic whites cannot be attributed to a greater prevalence of pre-existing conditions, lower neighborhood levels of education, or geographical disadvantage alone.
“Our results are consistent with a broader narrative that Black and Hispanic Americans face institutional disadvantages, including inconsistent health care providers, lower-quality care, and systemic racism, and combined, those effects contribute to COVID-19 health inequality,” Simon said.
The long-term effects of the inequalities are likely to continue, she said, as vaccination distributions have not aligned with who has been most affected by the virus.
About the O’Neill School of Public and Environmental Affairs
The O’Neill School is a world leader in public and environmental affairs and is the largest school of public administration and public policy in the United States. In the 2021 "Best Graduate Public Affairs Programs" by U.S. News & World Report, the O'Neill School ranks first in the country. Four of its specialty programs are ranked in the top-five listings, including nonprofit management, ranked first.