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COVID-19 Disparities Widened by Underlying Issues, Lack of Access to Care

A recent study attributed COVID-19 morbidity and mortality disparities to “upstream issues” such as underlying conditions and lack of access to testing and care.

The COVID-19 pandemic has exposed racial and ethnic disparities in the American healthcare system. While race and ethnicity have been correlated with morbidity and mortality rates, it is unknown whether these disparities also exist in exposure to the SARS-CoV-2 virus.

A study published in the Journal of Racial and Ethnic Health Disparities sought to explore whether these disparities exist at the exposure stage as well as the treatment stage. Investigators examined the hard-hit community of Essex County, New Jersey using serologic surveillance to find the underlying burden of disease.

From September 15, 2020, to December 22, 2020, the investigators employed venue-based-sampling (VBS) to sample residents of Essex County, who completed a brief electronic survey and provided a finger stick blood sample. They sampled 924 Essex County, NJ community members, eventually identifying 9.0% (n=83) participants as positive for COVID-19 antibodies.

The study sample was predominantly Black (71.0%), Latino (21.0%), and male (63.2%). The majority had graduated high school or had some college education (70.5%). Only 37.1% were employed full-time, with 47.8% reporting a personal income of less than $15000. 43.1% were unemployed, and 27.2% reported homelessness at some time in the preceding year; 19.6% were homeless at the time the study was conducted.

This antibody prevalence was higher than the locally reported rate, suggesting there may be more asymptomatic persons spreading COVID-19 than expected. The investigators approximated the pool of persons spreading the virus could be more than 6 times what the PCR results indicated.

“Higher antibody prevalence, with no notable difference in presence by race/ethnicity or frequency of leaving the home, indicates an individual’s health outcome may be dependent upon underlying conditions rather than increased exposure,” said study author Henry F. Raymond, associate professor in the Department of Biostatistics and Epidemiology at the Rutgers School of Public Health.

There was no significant difference in the number of Black and Latinx participants with COVID-19 antibodies in comparison to other races and ethnicities. Rather, the findings attributed disparate COVID-19 outcomes to underlying conditions, access to testing, and access to care. As a result, the investigators suggested a biopsychosocial understanding of COVID-19 that accounts for the structural and social inequities that undermine access to healthcare for marginalized populations.