Inequity, Not Genetics, the Main Factor in Covid Death Rates for Black Americans

Environmental racism. Discrimination. A justifiable distrust of government and health care professionals. Experts say these are just a few factors why black people are dying at higher rates in the coronavirus pandemic than their white counterparts.

Ambulances line the street outside Elmhurst Hospital Center in Queens, New York, last weekend. (AP Photo/Mary Altaffer)

(CN) — On April 9, the 13th person in St. Louis, Missouri, died of complications related to the novel coronavirus. 

While the 13 deaths in the 11th-largest city in the Midwest were not statistically aberrant nor particularly concerning from a purely epidemiological point of view, there was one alarming contextual aspect of those initial fatalities.

All 13 of the victims were black. 

Since then, four more St. Louis residents have succumbed to the disease — though three of them were not black. But the trends in St. Louis and more broadly throughout the United States consistently demonstrate that black communities have been disproportionately hit by the global pandemic. 

“If you look at the health disparities in the city of St. Louis, they’re not unique,” St. Louis’ health director Dr. Fredrick Echols said last week during a press briefing. 

Other major cities that have released demographic data for Covid-19 fatalities indicate similar trends.  

In Chicago, black residents comprise 30% of the city’s population but account for approximately 70% of the deaths. Statewide, black men and women account for about 43% of the approximately 530 deaths. Only 14% of residents in Illinois are black. 

In New York City, the epicenter of the outbreak in the United States, preliminary data released by the state showed that black and Latino individuals are dying at twice the rate as whites and Asians.

The age-adjusted rate for Covid-19 fatalities in New York City is 19.2 deaths per 100,000 confirmed cases for black residents. It is approximately half that for white residents — 10.2 deaths per 100,00.

It’s worse in parts of the South.

In Louisiana and Mississippi, black residents account for more than 60% of the coronavirus-related deaths, according to preliminary data. 

And the trend prevalent throughout the country, though the data are limited. Of the nearly 13,000 deaths from coronavirus as of April 9, racial data was available for about 3,300 victims — and 43% of them were black.

All the data raises a simple question — why? Is it socioeconomic, cultural or are their genetic factors at play?

“Listen, there could be a gene that African Americans carry that makes them more susceptible,” said Sean Valles, who studies health’s intersection with population demographics at Michigan State University. “It’s not impossible.”

But he also says it’s unlikely, particularly as there are a bevy of explanations that make much more sense. 

“On the other side, there is just so much damn evidence for the socioeconomic factors at play here,” Valles said. “First, all you have to do is look at the proportion of black people versus white people who are working jobs that can’t be done remotely.”

Health care givers, cashiers, grocers, public transportation employees and farmworkers are jobs often filled by people of color. 

Conversely, professional and business services — the sector of the economy most amenable to remote work — is underrepresented by black men and women, according to the Bureau of Labor Statistics. 

The same federal agency found black people have less access to paid leave than the general population, meaning a larger share must put themselves in harm’s way to earn their living. 

“Black people disproportionately have the type of jobs that put you at risk,” said Thomas LaVeist, the dean of the Tulane University School of Public Health. 

It’s not just where black residents work either, but also where they live. 

Census data from January 2020 showed that less than half of black Americans own their own home compared to 74% of white Americans, and are more likely to live in crowded apartment complexes that put them at increased risk of infection. 

There are environmental factors as well. 

A team of Harvard scientists published a study in early April that showed long-term exposure to air pollution increases the mortality associated with Covid-19. Combine those findings with the results of a U.S. Environmental Protection Agency study from 2018 found black people are more likely to live in areas with significant levels of air pollution when compared to white counterparts and the picture becomes clearer. 

“One of the insidious things about environmental racism is that proximity to industrial output affects property values and transportation options,” Valles said, adding that these properties are often the only places poor people can afford to live.  

Such realities could contribute to health factors in the black population as it pertains to conditions like asthma. Black Americans suffer asthma at three times the rate of white counterparts. 

Asthma is just one of several underlying conditions thought to be a prevalent risk to recovery from the coronavirus. 

According to the U.S. Center for Disease Control, people with chronic lung conditions, serious heart conditions, compromised immune systems, HIV/AIDS, diabetes, kidney or liver diseases or who are severely obese (a body mass index above 40) are all thought to be particularly vulnerable to the ravages of Covid-19. 

“As it relates to certain conditions, like diabetes or hypertension, African Americans have much higher rates of all those conditions,” LaVeist said. 

This fundamental health discrepancy could account for disparities in the mortality rates for whites versus blacks, even if the infection rates are relatively even. And the explanations put forward by Valles and LaVeist track with messages disseminated by the Trump administration. 

U.S. Surgeon General Jerome Adams said disproportionate deaths among black communities can be ascribed to social issues rather than genetic ones. 

“We do not think people of color are biologically or genetically disposed to get Covid-19,” Adams said during a briefing at the White House on April 10. “But they are socially predisposed to coronavirus exposure and to have a higher incidence of the very diseases that put you at risk for severe complications from coronavirus.” 

But Valles said many of those diseases, including diabetes, asthma and hypertension occur more frequently in the black population due to sociological factors like discrimination and environmental racism. 

“There is a growing body of literature that tries to track the direct health effects of racism,” Valles said. For instance, doctors have shown that incidents of discrimination lead to a direct spike in blood pressure. 

“There is like a constant stress response,” Valles said. 

Nevertheless, some have sought to downplay the sociological aspect of coronavirus mortality in America and instead look for biological explanations. 

It is true enough that some diseases at least appear to be more prevalent in some races. 

Sickle cell disease, for instance, is an almost exclusively black disease in the United States, partly due to a common genetic ancestry in some segments of the black population. Conversely, cystic fibrosis is extremely rare in black people and is instead found primarily in people of northern European ancestry. 

But sickle cell is also an example of why biological factors are to be taken skeptically. 

“Sickle cell is not a black disease,” LaVeist said. 

In fact, it is a geographical disease, prevalent in Mediterranean population, including individuals from countries in southern Europe like Italy, Greece and Spain. 

Many evolutionary biologists who have studied the disease speculate it was a mutation to give certain individuals an evolutionary advantage in developing resistance to malaria, LaVeist said. 

So while sickle cell disease may predominantly affect black people in the United States, many Europeans — particularly those in the south part of the continent — also contract the disease. 

It’s why genetic explanations for health outcomes in such a genetically diverse population as the contemporary black population are insufficient. 

“Sickle cell is not the reason life expectancies for black people are so much lower,” Valles said of the coronavirus pandemic. 

Just because scientists can find a few examples where race and genetics may contribute to a higher incidence of disease in a given demographic does not mean such rare instances should be used to explain away the social issues at work, Valles said.

“Economic resources, a justifiable mistrust of the government, the health profile of the black community before Covid-19 — these are all the factors,” LaVeist said. “Combine this with housing insecurity, food insecurity and having to work the types of jobs that don’t allow you to work from Zoom and you begin to understand the factors.”

Black Americans not only mistrust messages that come from the government, but studies have demonstrated they have trouble trusting medical professionals. 

In 2007, a group of researchers found black Americans were significantly likelier to express mistrust for their physician, with men of lower socioeconomic status being the most prone to ignore medical advice or treat it with suspicion. 

There is a legacy of the medical profession mistreating black Americans. The most notable example is the Tuskegee experiment, in which black men with syphilis were left untreated for decades so doctors could determine what happens when the disease is allowed to run its course. 

Other studies have shown persistent bias in how the medical system treats white patients versus black patients in contemporary American society. 

“These long-standing structural forms of discrimination that African Americans have faced … are manifesting in what we’re seeing with Covid right now,” said Kiarri Kershaw, an epidemiologist with Northwestern University in Chicago. 

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