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User:Rshrid/Racial Disparities in the COVID-19 pandemic in the United States/Draft

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The COVID-19 pandemic has had disproportionate effects on racial minorities in the United States, including increased infection rate, increased death rate, long-lasting detriment to educational outcomes, and decreased economic stability.

These effects have been most widely discussed by news sources in light of increased infection and mortality rates[1][2][3][4][5], but disproportionate effects expand to many other domains, illustrating how the pandemic has only worsened pre-existing inequalities for racial minorities[6].

These disproportionate effects are most readily discussed by considering (1) the nature of disproportionate impacts, including infection and mortality rates along with educational and economic disparities; (2) structural causes, such as social determinants of health, that predispose racial minorities to infection and mortality; and (3) predicted and observed effects of prior racial disparities becoming magnified because of COVID-19.

Disproportionate Impacts, their Causes, and Effects

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The COVID-19 pandemic has revealed and exacerbated inequalities through uneven effects present in many social domains[6]. Some of these impacts include disproportionate financial toll, crime, education, human rights, xenophobia and racism, impacts by gender, and racial inequalities. Racial inequalities, in specific, are largely influenced by inequalities in predisposing factors and infection rates[7], both of which have large impacts on morbidity, mortality, and effects indirectly attributable to COVID-19 infection[8].

Black Americans

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Main article: Impact of the COVID-19 pandemic on black people

Infection rate

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Recent literature shows that Black Americans in Chicago comprise over 50% of COVID-19 cases, while comprising only 30% of the city's population[9]. In Michigan, Black Americans, who comprise 14% of the population, suffered 33% of the state's COVID-19 cases[1]. These examples are representative of the scale and magnitude of disparities affecting Black communities across the US. In fact, in April 2020, The Johns Hopkins University and American Community Survey noted that responses from a survey of 131 predominantly Black communities in the US, the infection rate was 137.5 per 100,000 individuals, more than three times that of White Americans[9]. As the pandemic has progressed, racial inequalities haven't gone away. Data from September 2020 indicated that disproportionate infection rates by race still had oversize effects on Black Americans[10]. Further analysis through March 2021 has likewise indicated a persistent relationship between race and infection rates (i.e., that Black Americans had a higher infection rate than their White counterparts)[11].

Co-occurrence of chronic disease
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Closely associated with infection rates is the co-occurrence of chronic disease, since an underlying disease has been tightly linked to greater COVID-19 infection rates and worse outcomes[12][13][14].

Chronic disease has been associated with a number of factors, with diet and nutrition being a key contributor[15]. According to the Third National Health and Nutrition Examination Survey conducted from 1999 to 2002, Black Americans were 43% percent less likely than White Americans to consume vegetables and fruits at quantities meeting the USDA guidelines[16]. Moreover, according to the Behavioral Risk Factor Surveillance Survey data from 2000, Black Americans were the racial group least likely to consume vegetables and fruits five or more times per day[15]. While older studies are discussed above to demonstrate the long-standing disparity in access and quality of food consumption, new studies support persistence of these disparities. In fact, studies go as far as to claim "African Americans have an increased risk of cardiovascular disease partly due to low fruit and vegetable consumption"[17], and that peripheral artery disease reduction is associated with greater fruit and vegetable consumption[18]. As such, it's particularly salient that a western diet with low fruit and vegetable consumption may link to higher infection susceptibility and worse COVID-19 outcomes in Black and other minority communities[19], exacerbating a problem that has existed even before COVID-19.

Separate from food access and quality, chronic disease incidence itself bestows disproportionate burden of COVID-19[20]. Black Americans and other minority groups "have a disproportionate burden of chronic disease, SARS-CoV-2 infection, and COVID-19 diagnosis, hospitalization, and mortality", demonstrating how co-occurrence of chronic disease can adversely affect Black Americans[20]. In fact, the impact of these confluence of factors was succinctly addressed by US Surgeon General Jerome Adams[21]:

Number 1: [Black] people, unfortunately, are likely to be of low socioeconomic status, which makes it harder to social distance,

Number 2: We know that Blacks are more likely to have diabetes, heart disease, lung disease ...

I’ve shared myself personally that I have high blood pressure, that I have heart disease and spent a week in the ICU due to a heart condition, that I actually have asthma and I’m prediabetic, and so I represent that legacy of growing up poor and Black in America.

Association with built environment
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Early on during the COVID-19 pandemic, social distancing was heavily encouraged to minimize spread of COVID-19[22]. Naturally, these burden fell hardest on minority groups who are more constrained in their built environment[23]. Racial and ethnic minority groups have long been affected by challenges in finding affordable housing, partitioning them into regions that are often contain more buildings built upwards with less green space[24]. These build environments often suffer from overcrowding, and individuals tend to live in multi-generational homes which makes it difficult to maintain adequate social distancing[25][26].

Moreover, racial minorities are often employed in jobs that cannot be done from home -- as will be discussed in the next section on economic stability -- and even near the start of the pandemic many were obligated to go to work[2].

Mortality rate

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The disproportionate impacts on Black Americans has been manifest by dramatically increased mortality rates compared to other racial groups.

From data publicly available in April 2020, Black Americans averaged 6.3 deaths per 100k people, far more than the 1.1 deaths per 100k for White Americans[1]. More detailed statistical analysis conducted in October 2020 revealed an significant increase in mortality rate for Black (1.9%) vs non-Black (0.8%) participants, and even after adjusting for age the mortality rate disproportionately affected Black participants[27]. Even more recently in September 2021, the Hamilton Project at the Brookings Institution tabulated that Black mortality rate due to COVID-19 was almost 1.5x that of White Americans[28]. They argue that not only does this disproportionate mortality affect life expectancy, it also threatens Black Americans' recovery from COVID-19-related damages[28].

Association with economic stability

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Even prior to the COVID-19 pandemic, the Black-White wealth gap was pronounced, with many studies demonstrating its magnitude[29]. Data from the Center for American Progress demonstrates that Black Americans, with less in way of savings, were harder hit economically by the pandemic-associated recession[29][30]. Not only did the economic impacts have implications for long-term investment, they also affected quality and access to education during the pandemic, health outcomes, and retirement savings[29].

The Economic Policy Institute wrote that, especially early in the pandemic, there were three categories of workers: "[1.] those who have lost their jobs and face economic insecurity, [2.] those who are classified as essential workers and face health insecurity as a result, and [3.] those who are able to continue working from the safety of their homes"[31]. Further analysis revealed that Black Americans were losing their jobs at rates higher than White Americans, and those who retained their jobs were likely to be essential workers exposed to disproportionately high health risk[31][32].

Association with social and work relationships
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In October 2020, the KFF/Undefeated Survey on Race and Health found that 50% of Black respondents (compared to 42% White respondents) reported that they had lost a job or had their income reduced as a result of COVID-19. Moreover, 32% Black respondents reported that COVID-19 had a major impact on their ability to care for children (compared to 13% Whites) and 25% reported a major impact in their relationship with family members (compared to 12% Whites)[33]. These factors culminated in respondents stating that "it is a bad time to be Black in America"[33].

These findings were not isolated. In fact, an April 2020 analysis by the Center on Poverty and Social Policy at Columbia University found that working-age individuals, children, and Black Americans were most likely to fall into poverty due to COVID-19. At notable intersection of these categories lies Black kids, who are more likely than other groups to suffer long-term consequences from COVID-19[34].

Collectively, these findings recapitulate themes of disproportionately decreased economic stability, worsened social relationships, and either job layoffs or more dangerous working conditions for Black Americans.

Association with education access and quality
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A number of studies have documented unequal access to online education due to internet connectivity, technology access, etc[29][35]. These studies often bring attention to the inequalities in Black and White education quality, access, and outcomes, even before COVID-19[36]. As such, the pandemic has only exacerbated existing inequalities and deepened racial disparities.

On another side of the same issue, a July 2021 study by the Black Education Research Collective at Columbia University documented that Black participants noted decreased trust in educational systems, especially in the aftermath of many demonstrations of anti-Black racism[37].

Xenophobic and racist attitudes

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Main article: Xenophobia and racism related to the COVID-19 pandemic

Not only did racist institutions cause disproportionate effects on minority racial groups, as discussed above. Racism was also prominently manifested through social interaction, including significant anti-Asian sentiment and xenophobia on unprecedented scales[38].

References

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  1. ^ a b c Thebault, Reis, Andrew Ba Tran, and Vanessa Williams. “ The Coronavirus Is Infecting and Killing Black Americans at an Alarmingly High Rate.” African Americans are at higher risk of death from coronavirus - The Washington Post. The Washington Post, April 7, 2020. https://www.washingtonpost.com/nation/2020/04/07/coronavirus-is-infecting-killing-black-americans-an-alarmingly-high-rate-post-analysis-shows/.
  2. ^ a b Blow, Charles M. “Social Distancing Is a Privilege.” Opinion | Social Distancing During the Coronavirus Pandemic Is a Privilege - The New York Times. The New York Times, April 5, 2020. https://www.nytimes.com/2020/04/05/opinion/coronavirus-social-distancing.html.
  3. ^ Weber, Lauren. “ A Top Immunologist on Why Coronavirus Is Killing More African-Americans.” A Top Immunologist on Why Coronavirus Is Killing More African-Americans - WSJ. The Wall Street Journal, April 22, 2020. https://www.wsj.com/articles/a-top-immunologist-on-why-coronavirus-is-killing-more-african-americans-11587556800.
  4. ^ Reuters Staff. “U.S. COVID-19 Death Analysis Shows Greater Toll on Black, Hispanic Youth: CDC.” U.S. COVID-19 death analysis shows greater toll on Black, Hispanic youth: CDC | Reuters. Reuters, September 15, 2020. https://www.reuters.com/article/us-health-coronavirus-children-teens/u-s-covid-19-death-analysis-shows-greater-toll-on-black-hispanic-youth-cdc-idUSKBN26634U.
  5. ^ “Hispanic Americans Are Most Vulnerable to Covid-19.” Hispanic Americans are most vulnerable to covid-19 | The Economist. The Economist Newspaper, June 5, 2021. https://www.economist.com/united-states/2021/06/05/hispanic-americans-are-most-vulnerable-to-covid-19.
  6. ^ a b Blundell, Richard, Monica Costa Dias, Robert Joyce, and Xiaowei Xu. “COVID-19 and Inequalities.” Fiscal Studies 41, no. 2 (June 27, 2020): 291–319. https://doi.org/10.1111/1475-5890.12232.
  7. ^ Pan, Daniel, Shirley Sze, Jatinder S. Minhas, Mansoor N. Bangash, Nilesh Pareek, Pip Divall, Caroline ML. Williams, et al. “The Impact of Ethnicity on Clinical Outcomes in COVID-19: A Systematic Review.” EClinicalMedicine 23 (June 2020): 100404. https://doi.org/10.1016/j.eclinm.2020.100404.
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  9. ^ a b Yancy, Clyde W. “Covid-19 and African Americans.” JAMA 323, no. 19 (April 15, 2020): 1891–92. https://doi.org/10.1001/jama.2020.6548.
  10. ^ Wood, Daniel. “As Pandemic Deaths Add Up, Racial Disparities Persist — And In Some Cases Worsen.” Coronavirs Data By Race: Understanding the Disparities : Shots - Health News : NPR. NPR, September 23, 2020. https://www.npr.org/sections/health-shots/2020/09/23/914427907/as-pandemic-deaths-add-up-racial-disparities-persist-and-in-some-cases-worsen.
  11. ^ Kimani, Mumbi E., Mare Sarr, Yendelela Cuffee, Chang Liu, and Nicole S. Webster. “ Associations of Race/Ethnicity and Food Insecurity With COVID-19 Infection Rates Across US Counties.” JAMA Network Open 4, no. 6 (June 8, 2021). https://doi.org/10.1001/jamanetworkopen.2021.12852.
  12. ^ Laires, Pedro Almeida, Sónia Dias, Ana Gama, Marta Moniz, Ana R Pedro, Patricia Soares, Pedro Aguiar, and Carla Nunes. “ The Association Between Chronic Disease and Serious COVID-19 Outcomes and Its Influence on Risk Perception: Survey Study and Database Analysis.” JMIR Public Health and Surveillance 7, no. 1 (January 12, 2021). https://doi.org/10.2196/22794.
  13. ^ Islam, Nazrul, Ben Lacey, Sharmin Shabnam, A Mesut Erzurumluoglu, Hajira Dambha-Miller, Gerardo Chowell, Ichiro Kawachi, and Michael Marmot. “Social Inequality and the Syndemic of Chronic Disease and COVID-19: County-Level Analysis in the USA.” Journal of Epidemiology and Community Health 75, no. 6 (January 5, 2021): 496–500. https://doi.org/10.1136/jech-2020-215626.
  14. ^ Kompaniyets, Lyudmyla, Nickolas T. Agathis, Jennifer M. Nelson, Leigh Ellyn Preston, Jean Y. Ko, Brook Belay, Audrey F. Pennington, et al. “ Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children.” JAMA Network Open 4, no. 6 (June 7, 2021). https://doi.org/10.1001/jamanetworkopen.2021.11182.
  15. ^ a b Satia, Jessie A. “Diet-Related Disparities: Understanding the Problem and Accelerating Solutions.” Journal of the American Dietetic Association 109, no. 4 (April 2009): 610–15. https://doi.org/10.1016/j.jada.2008.12.019.
  16. ^ Casagrande, Sarah Stark, Youfa Wang, Cheryl Anderson, and Tiffany L. Gary. “Have Americans Increased Their Fruit and Vegetable Intake?: The Trends Between 1988 and 2002.” American Journal of Preventive Medicine 32, no. 4 (April 2007): 257–63. https://doi.org/10.1016/j.amepre.2006.12.002.
  17. ^ Barnidge, E. K., E. A. Baker, M. Schootman, F. Motton, M. Sawicki, and F. Rose. “ The Effect of Education plus Access on Perceived Fruit and Vegetable Consumption in a Rural African American Community Intervention.” Health Education Research 30, no. 5 (September 2, 2015): 773–85. https://doi.org/10.1093/her/cyv041.
  18. ^ Heffron, Sean P., Caron B. Rockman, Mark A. Adelman, Eugenia Gianos, Yu Guo, Jin Feng Xu, and Jeffrey S. Berger. “Greater Frequency of Fruit and Vegetable Consumption Is Associated With Lower Prevalence of Peripheral Artery Disease.” Arteriosclerosis, Thrombosis, and Vascular Biology 37, no. 6 (May 18, 2017): 1234–40. https://doi.org/10.1161/atvbaha.116.308474.
  19. ^ Butler, Michael J., and Ruth M. Barrientos. “The Impact of Nutrition on COVID-19 Susceptibility and Long-Term Consequences.” Brain, Behavior, and Immunity 87 (July 2020): 53–54. https://doi.org/10.1016/j.bbi.2020.04.040.
  20. ^ a b Hacker, Karen A., Peter A. Briss, Lisa Richardson, Janet Wright, and Ruth Petersen. “COVID-19 and Chronic Disease: The Impact Now and in the Future.” Preventing Chronic Disease 18 (June 17, 2021). https://doi.org/10.5888/pcd18.210086.
  21. ^ 'I And Many Black Americans Are at Higher Risk' - Surgeon General. 'I And Many Black Americans Are at Higher Risk' -Surgeon General | Reuters Video. Reuters, 2020. https://www.reuters.com/video/watch/idOVC8I00KF.
  22. ^ Glogowsky, Ulrich, Emanuel Hansen, and Simeon Schächtele. “How Effective Are Social Distancing Policies? Evidence on the Fight against COVID-19.” PLOS ONE 16, no. 9 (September 22, 2021). https://doi.org/10.1371/journal.pone.0257363.
  23. ^ Liao, Tim F, Dan Steward, and Caitlin Vitosky Clarke. “Section on Inequality, Poverty, and Mobility, the American Sociological Association.” Social Distancing Deals a Triple Blow to People of Color, June 2020. https://sociology.illinois.edu/system/files/2020-06/LiaoStewardClarkeASAIPMNewsletter0820.pdf.
  24. ^ Wen, Ming, Xingyou Zhang, Carmen D. Harris, James B. Holt, and Janet B. Croft. “Spatial Disparities in the Distribution of Parks and Green Spaces in the USA.” Annals of Behavioral Medicine 45, no. S1 (February 2013): 18–27. https://doi.org/10.1007/s12160-012-9426-x.
  25. ^ Airgood-Obrycki, Whitney. “High-Proximity Jobs and Household Vulnerabilities.” High-Proximity Jobs and Household Vulnerabilities | Joint Center for Housing Studies. Joint Center for Housing Studies of Harvard University, June 8, 2020. https://www.jchs.harvard.edu/blog/high-proximity-jobs-and-household-vulnerabilities.
  26. ^ Duque, Richard B. “Black Health Matters Too… Especially in the Era of Covid-19: How Poverty and Race Converge to Reduce Access to Quality Housing, Safe Neighborhoods, and Health and Wellness Services and Increase the Risk of Co-Morbidities Associated with Global Pandemics.” Journal of Racial and Ethnic Health Disparities 8, no. 4 (September 18, 2020): 1012–25. https://doi.org/10.1007/s40615-020-00857-w.
  27. ^ Adegunsoye, Ayodeji, Iazsmin Bauer Ventura, and Vladimir M. Liarski. “ Association of Black Race with Outcomes in COVID-19 Disease: A Retrospective Cohort Study.” Annals of the American Thoracic Society 17, no. 10 (October 2020): 1336–39. https://doi.org/10.1513/annalsats.202006-583rl.
  28. ^ a b Hardy, Bradley L, and Trevon D Logan. Rep. The Way Back: Assessing Economic Recovery Among Black Americans During COVID-19. The Brookings Institution, September 2021. https://www.brookings.edu/wp-content/uploads/2021/09/20210929_Hamilton_HardyLogan_TheWayBack.pdf.
  29. ^ a b c d Weller, Christian E, and Richard Figueroa. Rep. Wealth Matters: The Black-White Wealth Gap Before and During the Pandemic. Center for American Progress, July 28, 2021. https://www.americanprogress.org/issues/race/reports/2021/07/28/501552/wealth-matters-black-white-wealth-gap-pandemic/.
  30. ^ McIntosh, Kriston, Emily Moss, Ryan Nunn, and Jay Shambaugh. Rep. Examining the Black-White Wealth Gap. The Brookings Institution, February 27, 2020. https://www.brookings.edu/blog/up-front/2020/02/27/examining-the-black-white-wealth-gap/.
  31. ^ a b Gould, Elise, and Valerie Wilson. Rep. Black Workers Face Two of the Most Lethal Preexisting Conditions for Coronavirus—Racism and Economic Inequality . Economic Policy Institute, June 1, 2020. https://www.epi.org/publication/black-workers-covid/.
  32. ^ Edwards, Khadijah, and Mark Hugo Lopez. Rep. Black Americans Say Coronavirus Has Hit Hard Financially, but Impact Varies by Education Level, Age. Pew Research Center, May 12, 2021. https://www.pewresearch.org/fact-tank/2021/05/12/black-americans-say-coronavirus-has-hit-hard-financially-but-impact-varies-by-education-level-age/.
  33. ^ a b Hamel, Liz, Lunna Lopes, Cailey Muñana, Samantha Artiga, and Mollyann Brodie. Rep. Race, Health, and COVID-19: The Views and Experiences of Black Americans. Kaiser Family Foundation, October 2020. https://files.kff.org/attachment/Report-Race-Health-and-COVID-19-The-Views-and-Experiences-of-Black-Americans.pdf.
  34. ^ Glass, Kelly. “Black Families Were Hit Hard by the Pandemic. The Effects on Children May Be Lasting.” Black Families Were Hit Hard by the Pandemic. The Effects on Children May Be Lasting. - The New York Times. The New York Times, June 29, 2020. https://www.nytimes.com/2020/06/29/parenting/coronavirus-black-children-inequality.html.
  35. ^ cmaadmin. “COVID-19 Will Intensify Education Inequities for Black Students.” COVID-19 Will Intensify Education Inequities for Black Students | Diverse: Issues in Higher Education. Diverse Education, May 20, 2020. https://www.diverseeducation.com/opinion/article/15106915/covid-19-will-intensify-education-inequities-for-black-students.
  36. ^ Darling-Hammond, Linda. Rep. Unequal Opportunity: Race and Education. The Brookings Institution, March 1, 1998. https://www.brookings.edu/articles/unequal-opportunity-race-and-education/.
  37. ^ Paz, Isabella Grullón. “Pandemic and Racial Injustice Cause Outsize Harm to Black Students, Study Finds.” Pandemic and Racial Injustice Cause Outsize Harm to Black Students, Study Finds - The New York Times. The New York Times, July 27, 2021. https://www.nytimes.com/2021/07/27/us/covid-race-impact-black-education.html.
  38. ^ “ Increase in Hate Speech, Stigma, Discrimination, or Xenophobia.” Increase in hate speech, stigma, discrimination, or xenophobia - GNWP. Global Network of Women Peacebuilders, September 2, 2021. https://gnwp.org/resources/covid-19-wps-database/increase-in-hate-speech-stigma-discrimination-or-xenophobia-2/.
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