Experts say socioeconomic factors and hospital services are factors in the impact COVID-19 has had on Black Americans. Seventy Four/Getty Images
  • Researchers say there are major differences between Black and white communities regarding COVID-19 hospitalizations and death rates.
  • They say socioeconomic factors play a major role, including hospital care, the lack of transportation, and online services in communities of color.
  • They say possible solutions include helping underfunded medical facilities and reducing the number of uninsured people.

A few months into the pandemic, scientists say they’ve discovered a disturbing pattern.

The data showed that those who survived COVID-19 and those who didn’t breaks down sharply along racial lines, with Black people being hit particularly hard.

According to data from the Centers for Disease Control and Prevention (CDC), Black people develop COVID-19 at about the same rate as whites. But they are nearly three times more likely to be hospitalized and twice as likely to die from the disease.

Why is this happening?

Some scientists have said Black people have higher rates of chronic diseases that make them more vulnerable to COVID-19.

However, a new study published in JAMA Network Open suggests that may not be the whole story. Among other things, what hospital you land in could be a major factor.

“The effects of what hospital you go to are by far the greatest and, frankly, could entirely explain the Black-white differences we see in survival,” said Dr. David A. Asch, a lead author of the study and a professor of medicine and healthcare management as well as the director of the Center for Health Care Innovation at the University of Pennsylvania.

The study by the numbers

The researchers examined the data for more than 44,000 Medicare beneficiaries who were treated for COVID-19 at nearly 1,200 hospitals across the country.

They concluded that if Black patients were treated in the same hospitals as whites, their mortality rate could have been lower.

Asch told Healthline that their findings were true even after they accounted for chronic conditions such as hypertension and diabetes. His team did not specifically study what it was about the hospitals that made the difference.

“But there are some smoking guns. If you think about it, hospitals are a lot like public schools,” he said. “We fund them typically with local property taxes. So the schools in, say Beverly Hills have more resources than in impoverished neighborhoods.”

The reaction from other experts

Those findings ring a bell with Dr. Kim Rhoads, MPH, an associate professor of epidemiology and biostatistics and the director of the Office of Community Engagement at the University of California San Francisco (UCSF).

“Where you go determines what you get and what you get can determine your outcome,” she told Healthline.

Rhoads began studying the impact of hospitals on cancer treatment in 2008. She said she started looking for answers because all the literature blamed the patient for not taking care of themselves or not eating right.

Rhoads says the problem is that hospitals serving communities of color often have numerous people using Medicaid. The rate of reimbursement to the hospital for Medicaid-related services is on average 87 cents on the dollar.

“Their revenues are lower. So the types of specialists those hospitals can hire may be limited. The types of equipment they have to provide cancer care, like a radiation machine, is limited,” she said.

How did we get here?

Dr. Karen Joynt Maddox, MPH, an assistant professor at the School of Medicine and co-director at the Center for Health Economics and Policy at Washington University in St. Louis, said the disparities have roots in racism.

“Hospitals that disproportionately serve Black patients struggle for a number of reasons, but they all link back to structural racism,” she told Healthline.

Maddox says historical underinvestment and discrimination have effectively segregated those hospitals in communities of color.

“Policies like redlining means those hospitals are often located in areas that are much poorer with lower revenues,” she explained.

“It can be hard to recruit and retain physicians and other healthcare professionals to work in under-resourced hospitals,” she added.

More racial disparities

Scientists at New York’s Mount Sinai Hospital recently completed another study on COVID-19 racial disparities, focusing on a New York neighborhood.

They wanted to look beyond the discourse about how COVID-19 comorbidities were why Black Americans had higher mortality rates.

What they found was that neighborhoods that had higher socioeconomic disadvantages had more COVID-19 cases and deaths.

In addition, researchers at New York University Grossman School of Medicine looked at racial disparities in access to COVID-19 vaccines in Brooklyn.

They found a substantial number of “vaccination access deserts.” They said the early vaccine rollout focused on white neighborhoods that were middle and upper class.

Rhoads calls this the “car and computer” syndrome.

She said people in lower-income communities might not have a car to get to the vaccine sites and no way to go online to make an appointment.

Her UCSF team took vaccines to those communities and established pop-up sites in the San Francisco Bay Area. They registered people on the spot and did a phone follow-up for people who needed a second shot.

“I think the innovation that should come out of this pandemic is a bigger investment in the people in the community. That means engaging the community in the process of taking care of public health,” Rhoads said.

Possible solutions

Experts say the potential solutions are complicated.

“A systematic and intentional investment in hospitals that disproportionately serve Black individuals,” suggested Maddox. “And even beyond healthcare, economic development in neighborhoods and communities.”

Asch said one solution would be to decrease the number of uninsured people and find a way to get more revenue to the underfunded hospitals.

“What if Medicaid paid at higher rates than it does?” Asch said. “We could redress some of the financial differences, but it wouldn’t fix everything. It’s a tangled web. It’s not just money.”

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