- Non-Hispanic Black Americans are about 4.7 times as likely as non-Hispanic white Americans to be hospitalized with COVID-19. Black Americans are also more likely to die from the disease.
- The reasons for this increased risk are many, including systemic racism that affects the overall health outcomes for Black Americans.
- Black Americans are also more likely to work frontline jobs in public transportation, food services, and other sectors.
- Additionally, Black Americans have higher rates of obesity, which might contribute to increased risk of severe COVID-19.
The COVID-19 pandemic has been hitting Black Americans and many other people of color particularly hard in the United States.
According to data released by the Centers for Disease Control and Prevention (CDC), non-Hispanic Black Americans are about 4.7 times as likely as non-Hispanic white Americans to be hospitalized with COVID-19.
Black Americans are also more likely to die from the disease.
A new study from researchers at Tulane University Health Science Center in New Orleans, Louisiana, suggests that obesity among Black Americans may be one of the factors contributing to poor outcomes in those who contract the new coronavirus.
The authors of the study suggest that identifying risk factors for severe infection is important for guiding public health efforts to address the pandemic.
“It is of tremendous importance that we identify risk factors and those individuals who may be at increased risk for severe COVID-19 infection, so that we are able [to] dedicate efforts towards supporting those most affected and in need,” Dr. Christine Bojanowski, corresponding author of the study and an assistant professor in the department of medicine at Tulane University, said in a press release.
“Further inclusive research aimed at optimizing clinical care relevant to the African-American population is critical to ensure an equitable response to COVID-19,” she added.
High BMI linked to ICU admission
To identify risk factors for severe disease, Bojanowski and colleagues analyzed the medical charts of 158 Black patients with COVID-19 who went to Tulane Medical Center.
Among those patients, 46 were admitted to the intensive care unit (ICU) for treatment of COVID-19-related complications. Most of those patients were intubated and put on a mechanical ventilator due to respiratory failure.
Patients who were admitted to the ICU were older and had a higher body mass index (BMI) on average compared to those with less severe disease.
Among those admitted to the ICU, 76 percent were classified as having obesity, defined by the CDC as a BMI of 30 or higher. Among those with less severe disease, 54 percent had obesity.
Patients who were admitted to the ICU were also more likely than others to have preexisting lung disease, chronic kidney disease, diabetes, or high blood pressure.
This study adds to a growing body of evidence that links obesity and certain chronic health conditions to increased risk of severe infections and complications from COVID-19.
Social determinants of health
According to data from the National Center for Health Statistics, non-Hispanic Black American adults are more likely than any other racial or ethnic group in the United States to have obesity.
Many societal factors contribute to high rates of obesity among Black Americans, says Dr. Deidra Candice Crews, an associate professor and associate vice chair of diversity and inclusion in the department of medicine at John Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
“At a neighborhood level, I think residential segregation is one of the most glaring examples of structural racism in our country,” Crews told Healthline.
“Communities that are predominantly African American often lack access to healthy foods and places for recreation, that would both be in many ways protective against obesity,” she continued.
The psychosocial stress of racism has also been linked to increased risk of obesity in Black Americans, particularly Black women.
Inequitable living conditions
In addition to high rates of obesity and certain chronic health conditions, many other factors may help account for the disproportionate impact of COVID-19 on Black communities.
“Certainly obesity could be one factor that contributes to worse COVID outcome[s] among Black Americans, but it is unlikely to be the only factor,” said Ana Diez Roux, MD, PhD, MPH, dean of Dornsife School of Public Health and director of the Urban Health Collaborative at Drexel University in Philadelphia.
For example, many Black Americans live in overcrowded housing, which makes physical distancing impossible to practice, Diez Roux told Healthline.
Black Americans are also more likely to work frontline jobs in public transportation, food services, and other sectors, reports the Economic Policy Institute.
Many frontline workers have been unable to take time off or work from home during the pandemic, and may face barriers to maintaining physical distance from others at work.
Gaps in healthcare
Disparities in healthcare access also track along racial and ethnic lines, reports the CDC.
Lack of health insurance or limited access to quality healthcare may contribute to delays in testing, diagnosis, or treatment for many Black Americans who contract the virus that causes COVID-19.
Gaps in healthcare also make it harder for many Black Americans to manage chronic health conditions that may contribute to poor outcomes from COVID-19.
“The most important thing to recognize is that all these factors are rooted in social and economic circumstances experienced by Black Americans, linked to structural inequality, racism, and segregation,” Diez Roux said.
“In this, COVID-19 mirrors many other health outcomes for which we see significantly worse outcomes in Black Americans. COVID-19 has simply made even more visible these profound health inequities,” she added.