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Racism, Not Race, Drives Inequity Across the COVID-19 Continuum

Educational Objective
To understand that racism, not race, drives inequality across the COVID-19 continuum
1 Credit CME

Since the early stages of the coronavirus disease 2019 (COVID-19) pandemic, significant racial and ethnic inequities have persisted across the continuum of COVID-19 morbidity, hospitalization, and mortality. The US Centers for Disease Control and Prevention have estimated that COVID-19 case and hospitalization rates are at least 2.5 and 4.5 times higher, respectively, among Black, Hispanic, and Native American populations than among White populations.1 Black individuals have died from COVID-19 at more than twice the rate as White individuals.1 Area-based studies have similarly revealed elevated COVID-19 infection and death rates in socially disadvantaged counties with larger racial and ethnic minority populations.2 In the context of intergenerational, structural inequalities in the United States, these trends are as devastating as they are unsurprising. The need to elucidate factors associated with COVID-19 inequity and identify tangible action steps continues. Kabarriti et al3 and Muñoz-Price et al4 delve deeper into the racial and ethnic disparities across the COVID-19 care continuum by presenting findings from their urban, single-center, cross-sectional studies in the Bronx, New York, and Milwaukee, Wisconsin.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Published: September 25, 2020. doi:10.1001/jamanetworkopen.2020.19933

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Khazanchi R et al. JAMA Network Open.

Corresponding Author: Jasmine R. Marcelin, MD, Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198-5400 (jasmine.marcelin@unmc.edu).

Conflict of Interest Disclosures: Dr Evans reported consulting for BioK+. No other disclosures were reported.

References
1.
US Centers for Disease Control and Prevention. COVID-19 hospitalization and death by race/ethnicity. Published August 18, 2020. Accessed August 23, 2020. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html
2.
Khazanchi  R , Beiter  ER , Gondi  S , Beckman  AL , Bilinski  A , Ganguli  I .  County-level association of social vulnerability with COVID-19 cases and deaths in the USA.   J Gen Intern Med. Published online June 23, 2020. doi:10.1007/s11606-020-05882-3PubMedGoogle Scholar
3.
Kabarriti  R , Brodin  NP , Maron  MI ,  et al.  Association of race and ethnicity with comorbidities and survival among patients with COVID-19 at an urban medical center in New York.   JAMA Netw Open. 2020;3(9):e2019795. doi:10.1001/jamanetworkopen.2020.19795Google Scholar
4.
Muñoz-Price  LS , Nattinger  AB , Rivera  F ,  et al.  Racial disparities in incidence and outcomes among patients with COVID-19.   JAMA Netw Open. 2020;3(9):e2021892. doi:10.1001/jamanetworkopen.2020.21892Google Scholar
5.
Yehia  BR , Winegar  A , Fogel  R ,  et al.  Association of race with mortality among patients hospitalized with coronavirus disease 2019 (COVID-19) at 92 US hospitals.   JAMA Netw Open. 2020;3(8):e2018039. doi:10.1001/jamanetworkopen.2020.18039PubMedGoogle Scholar
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Chen  JT , Waterman  PD , Krieger  N . COVID-19 and the unequal surge in mortality rates in Massachusetts, by city/town and zip code measures of poverty, household crowding, race/ethnicity, and racialized economic segregation. Published May 9, 2020. Accessed August 22, 2020. https://tinyurl.com/y7qzot3l
7.
US Centers for Disease Control and Prevention. Excess deaths associated with COVID-19. Published August 19, 2020. Accessed August 23, 2020. https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
8.
Boyd  RW , Lindo  EG , Weeks  LD , McLemore  MR . On racism: a new standard for publishing on racial health inequities. Health Affairs Blog. Published July 2, 2020. Accessed August 31, 2020. https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/
9.
Laster Pirtle  WN .  Racial capitalism: a fundamental cause of novel coronavirus (COVID-19) pandemic inequities in the United States.   Health Educ Behav. 2020;47(4):504-508. doi:10.1177/1090198120922942PubMedGoogle ScholarCrossref
10.
Metzl  JM , Maybank  A , De Maio  F .  Responding to the COVID-19 pandemic: the need for a structurally competent health care system.   JAMA. 2020;324(3):231-232. doi:10.1001/jama.2020.9289PubMedGoogle ScholarCrossref
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