Care Access Drives COVID-19 Health Disparities in Black Populations

In the time since the COVID-19 pandemic has hit and spread across the US, the virus has further exposed glaring health disparities and lack of quality care access experienced by particular communities.

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In black populations, these inequities have been especially apparent.

Recent research from the Polis Center at Indiana University – Purdue University Indianapolis (IUPUI) showed that black residents of Marion County tested positive for COVID-19 at a rate nearly twice that of white residents.

The team also noted that as of May 5, 1,763 residents with confirmed COVID-19 cases were black and 1,979 were white. This means that for every 100,000 black residents, there are 646 confirmed cases, compared to 345 confirmed cases for every 100,000 white residents.

Researchers cited several reasons for these disparities, including food insecurity, housing instability, and the prevalence of underlying conditions like heart failure and diabetes.

Healthcare access also significantly impacts COVID-19 outcomes, the team found. Regular access to primary care tends to result in improved health, but black patients may not benefit from care access if they experience implicit bias from providers.

“Studies have found implicit bias causing white healthcare workers to view black patients as less cooperative and to offer black patients less treatment for pain. This bias can lead to reduced quality of care,” the team stated.

Black patients will also have a hard time accessing quality care if they don’t have health insurance. In Marion County, this is the reality for many black individuals, as 11.6 percent are uninsured – three percentage points higher than the uninsured rate for white residents.

“If someone does contract COVID-19, they will face steep financial hardship without health insurance to help with the cost of testing, doctor’s visits, or hospitalization,” IUPUI researchers said.

While being uninsured does exacerbate negative health outcomes, having health insurance doesn’t necessarily guarantee that patients will experience positive results. In a separate study conducted by Sutter Health and published in Health Affairs, researchers found that black COVID-19 patients are 2.7 times more likely to be hospitalized than their non-Hispanic white counterparts, and black individuals tend to present with more severe symptoms.

Sutter Health operates in an area that is one of the closest to universal healthcare coverage of any state in the US. These results indicate that despite having health insurance, black COVID-19 patients may not seek testing and care until it is an emergency situation. The study highlights the fact that when it comes to healthcare, expanded coverage may not be enough to reduce disparities.

“The real value of the study lies not in the disparities it reveals but in its utility to inform our work to develop solutions that will address the equity gaps we are seeing with programs such as community outreach and engagement in at-risk neighborhoods,” said Kristen M.J. Azar, RN, MSN/MPH, Sutter Health’s lead author for the study and research scientist within the Sutter Health Center for Health Systems Research. 

“This pandemic underscores the need to develop innovative solutions that are specifically tailored to address the unmet needs of those at highest risk.”

The findings of the COVID-19 study reflect findings from a 2017 Sutter Health study, which analyzed how black patients with asthma access care. The results showed that 72 percent of patients drove up to eight miles to a hospital emergency department to access care, even though they lived within one mile of a primary care clinic. The team found that these individuals were doing so because of a lack of culturally competent care.

Results from both the IUPUI study and the Sutter Health study highlight the significant need for community-based outreach and access to culturally competent care within black populations. With the onset of COVID-19, these efforts have only become more critical.

“The COVID-19 pandemic has ripped a Band-Aid off of the structural inequities that exist within our society – we must address these disparities right away because the cost of not addressing them is measured in human life,” said Stephen Lockhart, MD, PhD, chief medical officer at Sutter Health. 

“With lives on the line, we as a state can and should do better in connecting minority patients to culturally competent care – that is why Sutter Health has committed to advancing health equity and this study is just one part of our mission and work. We have a moral obligation to do so and must work together to meet this moment and lean into the opportunity to advance health equity for generations to come.”