It is now quite clear that the coronavirus disease (COVID)-19 leads to a much severe illness among the elderly and those with pre-existing health issues, such as cancer, diabetes, hypertension, obesity, compared to the general population. Additionally, racial inequities have also emerged in the context of this pandemic that have led the Centers for Disease Control and Prevention (CDC) to classify racial and ethnic minority groups, independent of age, in the high-risk population.

Data from June 2020 found age-adjusted rates of hospitalization were the highest among non-Hispanic American Indian and Alaska Native (AIAN) and non-Hispanic black individuals, followed by Hispanic individuals:

  • Non-Hispanic AIAN have a 5-times higher rate than non-Hispanic white persons
  • Non-Hispanic black persons have a 5-times higher rate than non-Hispanic white persons
  • Hispanic persons have a 4-times higher rate than non-Hispanic white persons

According to the Kaiser Family Foundation (KFF), the sudden surge of COVID-19 observed in the Southern and Western states in July 2020 will exacerbate the disparity in health care among non-white populations. These U.S. states are home to:

  • 71% of the nation’s Hispanic population
  • 59% of the nation’s Asian population
  • 57% of the nation’s AIAN population
  • 51% of the nation’s black population

July 6, 2020 data from 13 states that were reporting on the impact of race showed that blacks made up a larger share of COVID-19–related deaths compared to their share of the population, while Hispanics made up a larger share of COVID-19 cases compared to their share of the population. In Tennessee and Arkansas, for example, Hispanics make up three-times higher number of cases compared to their share of the population.

Challenges Facing Minority and Low-Income Populations

Language and cultural barriers among Hispanic and Asian populations can keep them from adequate access to health care even under normal circumstances—the pandemic may have aggravated this situation. Additionally, recent changes to immigration laws will add to the hesitancy of migrant families in accessing health services such as Medicaid and CHIP, especially if family members have mixed immigration status. U.S. Citizenship and Immigration Services did issue an alert in March 2020 to encourage everyone who needs preventive care or treatment for COVID-19 to do so, noting that the health services they seek would not have a negative impact on their future public charge tests.

KFF has identified several reasons for the high uninsured rate among non-citizens:

  • Limited access to employer-sponsored insurance
  • Eligibility restrictions for Medicaid, CHIP, and ACA Marketplace programs
  • Enrollment barriers among eligible individuals

Underlying disparities in health, social, and economic factors disproportionately increase the risks of COVID-19 among AIAN populations. Being at a higher risk for diabetes, heart disease, asthma, and obesity exacerbates the risk of serious illness due to COVID-19 in this demographic, along with living conditions that can increase their risk of exposure to the virus. KFF reported the following disparate statewide statistics among AIAN groups based on a July 6, 2020 update:

  • Montana – 6% of the population, 10.9% of the cases, 36.4% of the deaths
  • Wyoming – 2.3% of the population, 24.4% of the cases, 45% of the deaths
  • South Dakota – 8.6% of the population, 15.1% of the cases
  • Utah – <1% of the population, 2.5% of the cases, 5.4% of the deaths
  • Arizona – 3.9% of the population, 6.8% of the cases, 16.5% of the deaths
  • New Mexico – 8.8% of the population, 47.8% of the cases

While AIAN populations can turn to the Indian Health Service to receive care, they face issues with access if they live outside of tribal areas or if they do not belong to federally recognized tribes, which can affect their ability to seek care if they are infected during the current coronavirus pandemic.

The following COVID-19 statistics were reported among black populations:

  • South Dakota – 2.2% of the population, 13.8% of the cases
  • Minnesota – 6.6% of the population, 20.6% of the cases, 8.5% of the deaths
  • Iowa – 3.4% of the population, 9.0% of the cases, 5.0% of the deaths
  • Missouri – 11.4% of the population, 26.9% of the cases, 35.3% of the deaths
  • Wisconsin – 6.3% of the population, 17.1% of the cases, 23.6% of the deaths
  • Michigan – 13.7% of the population, 30.3% of the cases, 39.6% of the deaths
  • Ohio – 12.3% of the population, 26.6% of the cases, 19% of the deaths
  • West Virginia – 3.6% of the population, 6.9% of the cases
  • Vermont – 1.1% of the population, 10.2% of the cases
  • New Hampshire – 1.1% of the population, 5.1% of the cases, 1.8% of the deaths
  • Maine – 1.3% of the population, 23.5% of the cases, 1.8% of the deaths

The COVID-19 crisis has underscored the inaccessibility of much needed health resources to minority and low-income populations in the U.S. These learnings should be translated into social and health care policies that help mitigate risks associated with cultural differences, discrimination, living conditions, and financial status to improve access to care.

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