Managing Director & Partner
Against a backdrop of protests and a national conversation about systemic racism, disproportionate numbers of Black and Hispanic people in the US are dying from COVID-19. The prevailing view is that the higher number of deaths is due to three factors: underlying health conditions, the lack of access to quality health care, and exposure to the virus.
But our data analysis reveals that is not the case. Neither underlying health conditions nor the lack of access to quality health care has played a primary role in the discrepancy, though the latter was an issue early in the pandemic, when the lack of health insurance prevented many people from seeking treatment. Rather, the chief reasons for the disproportionate number of deaths are the greater risk of exposure to people with COVID-19 and less access to COVID-19 testing. By our calculations, these reasons account for about 85% of the disparity. Underlying health conditions, age, and the lack of access to quality health care account for the remaining 15%. (See Exhibit 1.)
The widespread misinterpretation of the data has had grave consequences. In particular, it has distracted policymakers from the immediate imperative to address the systemic racial disparities that are related to exposure as well as testing access. As a result, COVID-19 is again surging among people of color. Hispanic communities in the southern region of the US and in California are getting hit especially hard.
By contrast, Chicago’s journey toward health care equity in fighting COVID-19 shows that more can and should be done to safeguard communities of color. To reduce the spread of the coronavirus among people of color, it is vital to protect those who are essential workers and who are in high-contact occupations. It is also critical to expand the number of testing sites in communities of color and ensure sustained access to quality care.
To get a true sense of the impact of the pandemic on the lives of people of color, we analyzed data on COVID-19-related deaths, infection fatality rates (IFRs), and infection rates for Black, Hispanic, Asian, and white people in the US. We then investigated the root causes for the disparities among the different groups. (See “About Our Research.”)
The Number of Deaths. The data is sobering. For the US population, ages 18 through 65, Black people account for 32% of all COVID-19 deaths, despite making up only 14% of that population. (See Exhibit 2.) When we compared the number of COVID-19 deaths per 100,000 people aged 18 through 65 for each group, we found that the number of deaths for Black people is 5.8 times higher than it is for white people, while the number of deaths for Hispanics is 4.2 times higher than it is for white people.
Regional data yielded similar insights. Expectedly, the number of COVID-19 deaths for Black people and for white people varies significantly from state to state. But the number of COVID-19 deaths for Black people is higher than the average number for the general population in almost every state reporting this data. (See Exhibit 3.) In urban areas, the number of deaths for Black people is about 1.5 times higher; in rural areas, it is four times higher.
IFR. Epidemiologists define IFR as the percentage of people infected with the virus—regardless of whether they have been diagnosed—who are expected to die from it. In July, the World Health Organization stated that the current consensus global IFR for COVID-19 is .6%.
The IFR for a group depends primarily on the prevalence of underlying health conditions and age distribution. We estimate that for Black and Hispanic people in the US, the IFR is respectively .4% and .3%, slightly lower than the IFR for white people (.5%). For Asians, it’s even lower (.2%). The demographic base of older white people accounts for the majority of this estimate.
Infection Rates. Given US testing limitations and the high prevalence of asymptomatic cases, we have to estimate the true infection rate. Estimated infection rates depend on IFRs and the reported number of deaths per racial group. By our calculations, the infection rates for Black and Hispanic people are respectively three and two times higher than they are for white people. (See Exhibit 4.) This is important because it shows that infection rates for people of color are the primary reason for disparities in COVID-19 outcomes.
Why are death and infection rates so much higher for people of color than they are for white people? There are four factors to consider: the greater risk of exposure, less access to testing, underlying health conditions and age, and the lack of access to quality health care.
Greater Risk of Exposure. Of the various factors that are linked to infection, exposure to the virus is the most important because people of color are at significantly greater risk of exposure for various reasons related to social determinants of health. They are, for example, significantly more likely to live in multigenerational housing, use public transit, and work in environments where they are more exposed to the virus.
While only 16% of white people live in multigenerational households, that number is 60% to 80% higher for people of color. Nearly 30% of Asians live in multigenerational housing. In addition to multigenerational households, people of color in congregate living facilities (especially nursing homes, treatment centers, and prisons) have been hit hard by the coronavirus. To date, 60% of nursing homes that have a significant population (more than 25%) of people of color have reported COVID-19 cases, as opposed to 30% of nursing homes that have a small population (under 5%) of people of color. Prison residents are testing positive for the coronavirus at five times the rate of the general population.
Working conditions are especially problematic. Black and Hispanic people make up a disproportionate share of two groups of workers that have the highest risk of exposure.
Less Access to Testing. The data on testing reflects wide disparities between people of color and white people. The inequities have resulted from requirements for testing, access to tests and testing sites, skepticism about testing, and monolingual outreach.
Underlying Health Conditions and Age. People who have chronic health conditions, such as heart disease or diabetes, or who are over the age of 65 are especially vulnerable to COVID-19. If infected, these health-vulnerable individuals have a high risk of succumbing to the disease. Since a higher percentage of Black adults have underlying health conditions than do white adults (30%, compared with 25%), it is often assumed that underlying conditions are responsible for the higher number of COVID-19 deaths among Black people. (This does not apply to Hispanics, since only 20% have relevant chronic health conditions.)
That assumption is incorrect, however, because Black adults with underlying conditions are typically younger than white people with chronic conditions, largely offsetting the influence that such diseases have on the death rate. Approximately 25% of white people are over the age of 65, but only 16% and 9% of Black and Hispanic people, respectively, are over the age of 65. Overall, higher health vulnerability is not a significant cause of the higher number of deaths among people of color; by our estimate, it accounts for less than 5% of the difference.
Lack of Access to Quality Health Care. The last factor to be considered, health care access, has three key drivers:
We believe that a robust set of actionable policies is a good starting point for addressing the enormous racial disparities around COVID-19 outcomes that exist in the US today. The following list of policies is by no means exhaustive—see our fuller set of potential policies to protect the vulnerable. We mention these because they are especially relevant for communities of color and could help lower their overall death rates significantly.
The pandemic’s impacts on people of color go far beyond health issues. Economically, the crisis has led to people of color being laid off or furloughed in massive numbers. Approximately 24% of Black people and 20% of Hispanics have reported losing their jobs; those percentages are nearly twice the percentage of white people (11%) who have lost their jobs. According to the US Department of Labor, the gap between the unemployment percentage for people of color and for white people is the widest it’s been since May 2015.
The long-term consequences of COVID-19 for people of color are yet to be determined. But it is clear that the longstanding racial inequities that it has exacerbated are likely to keep growing if they are not addressed. As Black and Hispanic people continue to contract the coronavirus at two to three times the rate that white people do, the disease will spread further in communities of color. This will create a downward spiral of more lockdowns and more job losses, with the attendant problems of inadequate food and housing. And whenever COVID-19 cases surge in the future, they will disproportionately afflict people of color.
COVID-19’s impact on the lives of people of color has been broad, deep, and often misunderstood. It is past the time to do something about it.
The authors thank their colleagues for their contributions: Venkat Raman, for his research, analysis, and assistance in developing this article; Aradhana Parikh, for her research and demographic analysis; and Kelsey Hayes, for her research and help in identifying the policies.