Racial and Ethnic Hospitalizations in the Era of COVID-19

As we inch closer to a year of this COVID-19 pandemic, the ability to understand vulnerable patient populations, intervene to provide better care and support, and collect data is increasingly becoming a challenge. Simply put, we do not collect enough data to truly understand health disparities that are systemic in the United States. COVID-19 has highlighted this reality and as we attempt to understand such equity failings in the context of this pandemic, it becomes increasingly apparent that we struggle to even understand the problem.

Researchers from the University of Minnesota assessed this by breaking down state data on COVID-19 hospitalizations by race/ethnicity. By utilizing data reported through the University of Minnesota’s COVID-19 Hospitalization Tracking Project, they found that only 12 states across the United States truly report on race/ethnicity for those hospitalized during the study timeframe. From April 30 — June 24, 2020, those patients with COVID-19 and requiring hospitalizations were evaluated and the team worked to understand the cumulative hospitalizations by racial/ethnic categories.

The findings were ultimately quite telling in that the researchers evaluated the share of hospitalizations in comparison to that of the state population. For example, they found that the share of hospitalizations of white patients was smaller than their share of the state population within those 12 states. “Conversely, the percentage of hospitalizations among black patients exceeded the percentage of their representative proportion of the state population in all 12 states. Differences between the cumulative percentage of hospitalizations and the state population of black individuals were greatest in Ohio (31.8% vs 13.0%), Minnesota (24.9% vs 6.8%), Indiana (28.1% vs 9.8%), and Kansas (22.0% vs 6.1%).”

For Hispanic hospitalizations, they found that this was much higher than their representative proportion of the state population, especially in states like Virginia and Utah. The trend was reversed for hospitalization of Asian patients in that their rates were much lower when compared to population representation.

One particularly worrisome trend though, was hospitalization data for American Indian and Alaska Native. This has been a particularly hard-hit population disproportionately affected by the pandemic and yet there is poor data collected to truly understand the burden. The authors of this study noted that “Hospitalization data for American Indian and Alaskan Native populations were only reported by 8 states. However, the disparity was substantial in select states. In Arizona, the American Indian and Alaskan Native population accounted for 15.7% of the hospitalizations but only 4.0% of the state’s population. Similarly, in Utah, this subgroup accounted for 5.0% of the hospitalizations in contrast with 0.9% representation of the state population.”

In addition to revealing the considerable data gaps we have in the United States and how severely impacting this is to understanding the pandemic, this study highlights the deeply rooted disparities for many peoples within the United States. Access to and quality of care is critical, especially during a pandemic. Unfortunately, this data point to just the tip of the iceberg in terms of what we need to do to understand racial and ethnic disparities in relation to the COVID-19 pandemic.