A new analysis shows a wider gap in Minnesota between the rates at which white residents and those in racial and ethnic minority groups have suffered from COVID-19.
For more than a month, state data have shown that black, Asian and Hispanic residents run disproportionate risks related to COVID-19. Numbers released last week by the Minnesota Department of Health better illustrate the problem, state officials say, by adjusting for the age of those who have gotten sick.
The new analysis shows that black Minnesotans have the highest age-adjusted death rate among all racial and ethnic groups at 70 per 100,000 residents. The age-adjusted rate for whites is about 20 deaths per 100,000 people.
Beyond differences in death rates, the report found even larger gaps in the rate at which COVID-19 patients from different groups are being hospitalized or placed in intensive care.
“We know that we have disparities, and it’s a real problem,” Kris Ehresmann, the director of infectious disease at the Health Department, said Saturday. “But this helped us recognize that it was a greater problem than we had even been reporting.”
The disparities have nothing to do with a different biology or disease process, Ehresmann said during a call with reporters last week. “It’s the conditions in the community,” said Health Commissioner Jan Malcolm.
The state numbers add to a series of reports showing how racial and ethnic minority groups have been hit hard by COVID-19.
Last week, the U.S. Centers for Disease Control and Prevention published a study looking at care at one large health care system in Atlanta and found that being black was among the factors that raised the chances of being hospitalized for COVID-19. It found that while blacks accounted for 79% of patients hospitalized with the virus, they accounted for just 45% of nonhospitalized patients.
“The independent association between black race and hospitalization in this investigation remained, even when the analysis controlled for other characteristics (including diagnosed underlying conditions),” researchers wrote. That suggests “underlying conditions alone might not account for the higher rate of hospitalization among black persons.”
Earlier this month, the New England Journal of Medicine published a study of COVID-19 patients treated at a large health system in Louisiana and found that about 77% of those hospitalized with COVID-19 were black, whereas blacks made up only 31% of the health system’s overall patient population.
Worse underlying problems
The medical journal posted a podcast discussion of the study, where Dr. Eric Rubin, the editor-in-chief, said the results suggest black patients were just as likely as others to get good care once they were in the hospital. The problem was that black patients arrived with much more serious health problems, Rubin said, which could represent unequal access to health care.
Higher risk for serious COVID-19 illness continues a theme where social factors ranging from employment status and residential segregation to economic inequality contribute to a number of health problems for African-Americans, said Dr. Michele Evans, a senior investigator and deputy scientific director at the National Institute on Aging.
“Many African-Americans and other minorities occupy jobs that are classified as essential workers, that do not provide the privilege of working from home,” Evans said during the podcast. She added: “Income inequality is a severe problem, and that drives people to decrease their ability to protect themselves from, in this case, the virus.”
In Minn., 12 more die
In Minnesota, the Health Department reported Saturday that 12 more people have died of COVID-19, bringing the pandemic’s statewide toll to 1,372 deaths.
Residents of long-term care and assisted-living facilities accounted for nine of the 12 newly announced deaths. The state reported its first death involving someone whose residence was described as homeless/sheltered — a category that includes those in shelters, supportive housing and encampments as well as those homeless without a shelter.
COVID-19 is a viral respiratory illness. Those at greatest risk include people 65 and older, residents of long-term care facilities and those with underlying medical conditions. The medical conditions range from lung disease, serious heart conditions and cancer to severe obesity, diabetes and failing kidneys.
Most patients with COVID-19 don’t need to be hospitalized. The illness usually causes mild to moderate sickness, and some who are infected don’t have symptoms.
The new Health Department report shows that white residents in Minnesota account for more COVID-19 cases, hospital stays and deaths, but their share is lower than their 83% share of the state’s population.
To adjust for population, the Health Department calculated rates per 100,000 state residents.
By that basis in late May, whites were dying from COVID-19 at a rate of 13 per 100,000, Ehresmann said, whereas blacks were dying at a rate of 15 per 100,000 people. Whites tend to be older, though, so age adjustment lowered the rates for white residents and increased it for black residents.
“This age-adjusted method allows us to see the full impact of the disparities,” Malcolm told reporters Thursday.
The adjustment for age also shows that Asians and Hispanics are being hospitalized for COVID-19 at a higher rate than state officials previously understood.
The new report says that Asians are hospitalized at an age-adjusted rate of 146 per 100,000 while the rate for Hispanics is 247 per 100,000; whites are hospitalized at a rate of 19 per 100,000 people. Asians and Hispanics wind up in ICU units at a higher age-adjusted rate, as well.
Health disparities complex
While social factors lead to health disparities, hospitals are working hard to make sure they aren’t reinforced by the care they provide with COVID-19 patients, said Syl Jones, equity and inclusion director at Hennepin Healthcare. Jones works on a committee that helps make sure patients get fair access to advanced treatments.
Health disparities are complex because they’re multi-factoral.
“It’s really clear that people of color have many more co-morbidities to start with,” Jones said. “All of this can be chalked up to systemic racism, in some ways. Genetics and lifestyle choices are also important factors, as well.”
The net count for positive test results grew by 436 confirmed cases in the past day, bringing the total to 32,467 cases overall. With 16,815 tests completed, it was one of the state’s largest days by testing volume thus far.
Recent downward trends in the number of hospitalized patients continued Saturday, with 324 in the hospital including 161 people in intensive care.
More than 3,700 people have been hospitalized in Minnesota since the state reported its first case in early March.
Numbers released Saturday show health care workers have accounted for 3,348 cases statewide. A total of 28,205 Minnesotans who were infected with the novel coronavirus no longer need to be in isolation, up from 27,709 people at Friday’s data release.
Confirmed cases have been reported in 86 of the state’s 87 counties, with no cases in Lake of the Woods County in far northern Minnesota.
The Health Department added to its list of congregate care facilities publicly identified with at least one COVID-19 case among residents or staff, upping the total by two to 317 facilities. State officials are releasing names only for facilities with at least 10 cases among residents.
This week, the Health Department started allowing outdoor and window visits for residents at nursing homes and assisted-living facilities under strict new guidelines.