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Health Agencies Update
August 25, 2020

Household Composition May Explain COVID-19 Racial/Ethnic Disparities

JAMA. 2020;324(8):732. doi:10.1001/jama.2020.14375

Exposure to the novel coronavirus at work or at home may be more important than underlying health conditions in explaining why Black and Hispanic adults are more likely to die from coronavirus disease 2019 (COVID-19) than White adults, a recent study from the Agency for Healthcare Research and Quality suggests.

Living with a health-sector worker was more likely among Black than White adults, which a study suggested may help explain higher coronavirus disease 2019 death rates among Black people.

iStock.com/SDI Productions

In many parts of the US, Black and Hispanic people are more than twice as likely as non-Hispanic White individuals to die from COVID-19, the authors noted. One common hypothesis is that racial and ethnic disparities in COVID-19 death rates are related to having higher rates of preexisting conditions, including extreme obesity, asthma, heart disease, and cancer.

Data from the Medical Expenditure Panel Survey showed that Black adults in every age group were more likely than White adults to have health risks associated with severe COVID-19. However, White persons on average were older than Black individuals, so when all factors were considered, Whites tended to have a higher overall risk for severe COVID-19 than Blacks, whereas Hispanics and Asians had a much lower overall risk than Whites or Blacks.

When they examined other possible explanations for the racial/ethnic disparities in COVID-19 deaths, the researchers calculated that 13.3% of Black workers and 12.5% of Hispanic workers were in essential jobs that allowed them to work from home compared with 22.8% of White workers in essential jobs. They also found that Black adults at high risk of severe COVID-19 were 60% more likely than White adults to live with health-sector workers whose jobs raise their infection risk.

“We believe that COVID-19 disparities will ultimately be shown to stem from disparities in exposure,” the authors concluded.