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      Racial Disparities in COVID‐19 Mortality Among Essential Workers in the United States

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          Abstract

          Racial disparities are apparent in the impact of coronavirus disease 2019 (COVID‐19) in the United States, yet the factors contributing to racial inequities in COVID‐19 mortality remain controversial. To better understand these factors, we investigated racial disparities in COVID‐19 mortality among America's essential workers. Data from the American Community Survey and Current Population Survey was used to examine the correlation between the prevalence of COVID‐19 deaths and occupational differences across racial/ethnic groups and states. COVID‐19 mortality was higher among non‐Hispanic (NH) Blacks compared with NH Whites, due to more NH Blacks holding essential‐worker positions. Vulnerability to coronavirus exposure was increased among NH Blacks, who disproportionately occupied the top nine essential occupations. As COVID‐19 death rates continue to rise, existing structural inequalities continue to shape racial disparities in this pandemic. Policies mandating the disaggregation of state‐level data by race/ethnicity are vital to ensure equitable and evidence‐based response and recovery efforts.

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          Stigma as a fundamental cause of population health inequalities.

          Mark Hatzenbuehler, Jo C. Phelan, Bruce G. Link (2013)
          Bodies of research pertaining to specific stigmatized statuses have typically developed in separate domains and have focused on single outcomes at 1 level of analysis, thereby obscuring the full significance of stigma as a fundamental driver of population health. Here we provide illustrative evidence on the health consequences of stigma and present a conceptual framework describing the psychological and structural pathways through which stigma influences health. Because of its pervasiveness, its disruption of multiple life domains (e.g., resources, social relationships, and coping behaviors), and its corrosive impact on the health of populations, stigma should be considered alongside the other major organizing concepts for research on social determinants of population health.
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            "Weathering" and age patterns of allostatic load scores among blacks and whites in the United States.

            Arline T Geronimus, Margaret Hicken, Danya Keene … (2006)
            We considered whether US Blacks experience early health deterioration, as measured across biological indicators of repeated exposure and adaptation to stressors. Using National Health and Nutrition Examination Survey data, we examined allostatic load scores for adults aged 18-64 years. We estimated probability of a high score by age, race, gender, and poverty status and Blacks' odds of having a high score relative to Whites' odds. Blacks had higher scores than did Whites and had a greater probability of a high score at all ages, particularly at 35-64 years. Racial differences were not explained by poverty. Poor and nonpoor Black women had the highest and second highest probability of high allostatic load scores, respectively, and the highest excess scores compared with their male or White counterparts. We found evidence that racial inequalities in health exist across a range of biological systems among adults and are not explained by racial differences in poverty. The weathering effects of living in a race-conscious society may be greatest among those Blacks most likely to engage in high-effort coping.
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              A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test.

              Ivy W. Maina, Tanisha D. Belton, Sara Ginzberg … (2018)
              Disparities in the care and outcomes of US racial/ethnic minorities are well documented. Research suggests that provider bias plays a role in these disparities. The implicit association test enables measurement of implicit bias via tests of automatic associations between concepts. Hundreds of studies have examined implicit bias in various settings, but relatively few have been conducted in healthcare. The aim of this systematic review is to synthesize the current knowledge on the role of implicit bias in healthcare disparities. A comprehensive literature search of several databases between May 2015 and September 2016 identified 37 qualifying studies. Of these, 31 found evidence of pro-White or light-skin/anti-Black, Hispanic, American Indian or dark-skin bias among a variety of HCPs across multiple levels of training and disciplines. Fourteen studies examined the association between implicit bias and healthcare outcomes using clinical vignettes or simulated patients. Eight found no statistically significant association between implicit bias and patient care while six studies found that higher implicit bias was associated with disparities in treatment recommendations, expectations of therapeutic bonds, pain management, and empathy. All seven studies that examined the impact of implicit provider bias on real-world patient-provider interaction found that providers with stronger implicit bias demonstrated poorer patient-provider communication. Two studies examined the effect of implicit bias on real-world clinical outcomes. One found an association and the other did not. Two studies tested interventions aimed at reducing bias, but only one found a post-intervention reduction in implicit bias. This review reveals a need for more research exploring implicit bias in real-world patient care, potential modifiers and confounders of the effect of implicit bias on care, and strategies aimed at reducing implicit bias and improving patient-provider communication. Future studies have the opportunity to build on this current body of research, and in doing so will enable us to achieve equity in healthcare and outcomes.
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                Author and article information

                Contributors
                Tiana N. Rogers: tiana.rogers@sorensonimpact.com
                Journal
                Journal ID (nlm-ta): World Med Health Policy
                Journal ID (iso-abbrev): World Med Health Policy
                Journal ID (doi): 10.1002/(ISSN)1948-4682
                Journal ID (publisher-id): WMH3
                Title: World Medical & Health Policy
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 2153-2028
                ISSN (Electronic): 1948-4682
                Publication date (Electronic): 05 August 2020
                Electronic Location Identifier: 10.1002/wmh3.358
                Author notes
                [*] [* ] Corresponding author: Tiana N. Rogers, tiana.rogers@ 123456sorensonimpact.com

                Author information
                http://orcid.org/0000-0002-3571-8229
                Article
                Publisher ID: WMH3358
                DOI: 10.1002/wmh3.358
                PMC ID: 7436547
                PubMed ID: 32837779
                SO-VID: 29564d05-bd8c-4b35-9875-edd098e90d38
                Copyright © © 2020 Policy Studies Organization
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Date received : 29 April 2020
                Date revision received : 27 May 2020
                Date accepted : 06 July 2020
                Page count
                Figures: 0, Tables: 3, Pages: 17, Words: 6678
                Funding
                Funded by: National Cancer Institute , open-funder-registry 10.13039/100000054;
                Award ID: K01CA234319
                Categories
                Subject: Invited Article
                Subject: Invited Articles
                Custom metadata
                source-schema-version-number 2.0
                edited-state corrected-proof
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.7 mode:remove_FC converted:19.08.2020

                Keywords: coronavirus,health status disparities,infectious diseases,occupational health,race factors,viral transmission
                Data availability:
                Keywords: coronavirus, health status disparities, infectious diseases, occupational health, race factors, viral transmission

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