Minorities and Healthcare
As a whole, racial minorities, particularly black and Latino people, have more health comorbidities. This is due to a wide array of factors including structural elements, socioeconomic considerations, and others.
African American individuals in the United States, compared to white people, are –
- 40% more likely to be diagnosed with high blood pressure
- Twice as likely to-
- Have heart failure
- Receive a colon and prostate cancer diagnosis
- Three times as likely to-
- Be diagnosed with Chronic Kidney Disease (CKD)
- Lose their lives to complications associated with asthma
- Are 44% of HIV positive patients
Latino individuals are-
- Twice as likely to-
- Have diabetes
- Die from diabetes
- Be diagnosed with chronic liver disease
Minorities and Coronavirus
In the US, minorities have been affected disproportionately by the coronavirus pandemic. It’s been estimated that the virus is twice as deadly for black and Latino people. In Chicago, as well as Louisiana, black people comprise about 33% of the population. In both areas, they have accounted for 70% of deaths from COVID-19.
What is worse, is that due to time constraints and language barriers, many of the patients who speak Spanish aren’t able to hear their options from an interpreter. Some of these conversations surround end-of-life wishes for a loved one. ICU doctors and emergency room physicians are spending every minute of their time caring for patients. The conversations take place quickly in broken Spanish, and who is to say how much is understood.
Another issue is that many patients who are a member of these populations are physically unable to self-isolate once discharged from the hospital. They live in large households, and many are or live with essential workers, so they are not able to strictly social distance.
Crisis Standards of Care
But how might being a minority affect someone’s care?
During this pandemic, many states and hospitals have issued crisis standards of care (CSCs). These are guidelines which help them to ration their resources to support those who are most likely to benefit from them when the situation becomes dire.
For example, in Massachusetts and Colorado, a patient’s age, SOFA score, and comorbidities are analyzed. A SOFA score is a number calculated by laboratory values taken at the patients admittance, which determines how critical their illness is. Comorbidities are underlying medical conditions which a patient has already been diagnosed with, and which may affect their chances of recovering from COVID-19.
Of course, this system aims to outline the fairest process during unprecedented times of crisis. But focusing on comorbidities as a criteria unintentionally and disproportionately affects minority patients.
It is problematic because so much of COVID-19 is still unknown. We don’t really know which comorbidities are likely to lead to the most severe coronavirus cases. Recent studies have shown that men are more likely to experience severe illness than women. However, sex isn’t included in CSC guidelines. In some ways, this makes the system arbitrary, and unfortunately minorities are the ones most affected by this system.
So, what do we do?
What Can be Done?
Since the coronavirus is so novel, we don’t have all of the answers. However, we do know that comorbidities do affect outcomes, and these realistically should be included in CSCs.
However, advocates are asking for these to be reevaluated. Only the comorbidities which are known to have an impact on prognosis should be included. Further, it’s important to have a diverse group of professionals making these decisions. Finally, demographic data of patients should be tracked to ensure no hospital is denying minorities resources disproportionately.
You can read more about this issue here.
