Racial gaps in COVID-19 pandemic stem from social inequities

[CharonY]

It is well known by now that COVID-19 in the USA has disproportionately affected Black persons and Hispanics (with deaths about triple the rate compared to white folks). As usual there are speculations regarding e.g. genetic factors but also socioeconomic disparities. A recent study looked at the reasons and found that the neighbourhood socialeconomic status seems to be the crucial factor. This further highlights how pervasive inequality endangers public health as well as highlights how addressing these inequalities could benefit it.

It is also a cautionary tale to immediately assume a genetic basis when one finds ethnic/racial disparities in studies (something that only relatively recently has been embraced more by the scientific community).

[J.C.MacSwell]

On 12/9/2020 at 12:44 PM, CharonY said:

It is well known by now that COVID-19 in the USA has disproportionately affected Black persons and Hispanics (with deaths about triple the rate compared to white folks). As usual there are speculations regarding e.g. genetic factors but also socioeconomic disparities. A recent study looked at the reasons and found that the neighbourhood socialeconomic status seems to be the crucial factor. This further highlights how pervasive inequality endangers public health as well as highlights how addressing these inequalities could benefit it.

It is also a cautionary tale to immediately assume a genetic basis when one finds ethnic/racial disparities in studies (something that only relatively recently has been embraced more by the scientific community).

Here is an article that considers the effects of having some Neanderthal DNA. While it really is about that, it does mention agreement on your point about socioeconomic factors:

""We can't blame Neanderthals for Covid. That's a damaging response, and that's why I want to emphasize so much the social and environmental factors are the real things that people should be worrying about," said Tony Capra, a geneticist at the University of California, San Francisco's Bakar Computational Health Sciences Institute."

https://www.cnn.com/2020/12/09/health/neanderthal-genes-human-health-covid19-scn-wellness/?hpt=ob_blogfooterold

Not that I would consider actual blame in any case. If some groups had DNA that made them more susceptible to getting Covid, that should weigh in on their risk reduction efforts, and when they might be vaccinated as vaccines become available.

[CharonY]

2 hours ago, J.C.MacSwell said:

Not that I would consider actual blame in any case. If some groups had DNA that made them more susceptible to getting Covid, that should weigh in on their risk reduction efforts, and when they might be vaccinated as vaccines become available

Yes, potentially. The big issue is that there is often a disconnect between the biological effect size of genetic factors and how folks (including medical professionals and scientists) interpret the data. It has been hammered into our brain that genetic effects are huge, whereas in truth most of our knowledge now indicates that things are way more subtle, and/or way overshadowed by non-genetic factors.

In fact, this pandemic has shown us that social efforts (including simple things such as washing hands and keeping distance) are far more effective in reducing death than putting hopes into miracle cures, which I feel is a somewhat related mindset.

[J.C.MacSwell]

3 minutes ago, CharonY said:

Yes, potentially. The big issue is that there is often a disconnect between the biological effect size of genetic factors and how folks (including medical professionals and scientists) interpret the data. It has been hammered into our brain that genetic effects are huge, whereas in truth most of our knowledge now indicates that things are way more subtle, and/or way overshadowed by non-genetic factors.

In fact, this pandemic has shown us that social efforts (including simple things such as washing hands and keeping distance) are far more effective in reducing death than putting hopes into miracle cures, which I feel is a somewhat related mindset.

If this is in context to the coming vaccines I hope you this means so far, currently, and for not too many months in the future.

[CharonY]

17 minutes ago, J.C.MacSwell said:

If this is in context to the coming vaccines I hope you this means so far, currently, and for not too many months in the future.

Yes, outside of vaccines, I was thinking about the fact that folks would promote unproven treatments and deride simple but effective measures. And technically, if we kept or distance for, say two months on a global scale, we would be effectively burning the virus out, too. 

But again, it is worthwhile to remember that even during the rollout, distancing and protection measures must continue in order to keep deaths down. We do not have sufficient evidence that immunized folks are unable to transmit the disease, for example.

[PhilGeis]

In terms of "unproven" - what specific social factor(s) associated with "inequality" was responsible for the observed difference?  Could it be a cultural - in terms of difference in distancing and mask use practices?

[MigL]

There are few biological factors which affect the outcome of COVID infections.
One such is Vitamin D, or its deficiency in certain groups.

A large factor seems to be access to health care.
Our response, in Canada, while not perfect ( remote indigenous communities are  more affected ), has ben better than the US response, because people, no matter their socio-economic status, are not afraid to seek health care.
Americans, who don't have universal health care may be afraid of incurring the large costs associated with your health care system, and experience worse outcomes.

Maybe J Biden can push for expanded health care coverage in the US, based on these findings.

[CharonY]

On 2/15/2021 at 5:38 AM, PhilGeis said:

In terms of "unproven" - what specific social factor(s) associated with "inequality" was responsible for the observed difference?  Could it be a cultural - in terms of difference in distancing and mask use practices?

They used zipcodes (to calculate neighborhood socio-economic status), insurance status as well as health factors. After adjustment the racial disparities for SES, the differences for infection likelihood vanished. It is much less likely that folks with lower SES are less culturally inclined to distance, but likely have a job which makes it difficult.

 

On 2/15/2021 at 7:31 AM, MigL said:

There are few biological factors which affect the outcome of COVID infections.
One such is Vitamin D, or its deficiency in certain groups.

 

Comorbidities do not seem to fall along racial lines. Even adjusted only Asians were slightly more likely to get hospitalized than white folks. The higher infection rate seems to be the driver. The study is in fact specifically addressing this question. I.e. are there groups with higher susceptibility. And the answer so far is socioeconomic status is, but not membership in a racial group per se.

In a broader sense, these types of studies are important to figure out whether there are in fact biological differences, as it is not uncommon that these are overestimated when looking at racial differences.

These often result in racial stereotypes that negatively impact healthcare. Common examples include how especially black folks are treated when it comes to cardiovascular or pain treatments.

This does include the Canadian health system (recent examples in the news were probably more about just regular systemic racism rather than the medically misguided practices but often they are somewhat connected).

 

As a whole it is one of the newer studies which aim to deconvolute potentially genetic/biological factors and other confounding factors. The result of this study highly suggest a dominating effect of SES over genetic ones. 

[MigL]

Then again, there's also this ...

A genomic region associated with protection against severe COVID-19 is inherited from Neandertals | PNAS

Which suggests that a genetic mutation found to reduce the risk of severe Covid-19 outcomes by 1/5, was found in all existing samples of Neanderthal DNA, and in about 1/3 of samples from people of European and Asian origin.

Make of it what you will , but it does suggest genetic factors cannot be dismissed entirely.

[CharonY]

2 hours ago, MigL said:

Then again, there's also this ...

A genomic region associated with protection against severe COVID-19 is inherited from Neandertals | PNAS

Which suggests that a genetic mutation found to reduce the risk of severe Covid-19 outcomes by 1/5, was found in all existing samples of Neanderthal DNA, and in about 1/3 of samples from people of European and Asian origin.

Make of it what you will , but it does suggest genetic factors cannot be dismissed entirely.

Potentially not, however the effect in clinical settings seems to be actually fairly low. For example in the other cohort, African Americans, which likely have a lower frequency of these alleles are not more likely to get severely ill compared to white folks, once SES is taken into account. I.e. while it might (or might not) contribute to individual risk, other factors play a much higher factor. 

I.e. the issue always is that diseases and other conditions are almost always multifaceted. And the issue here is that many risk factors are stratified along racial lines (depending on country). To distinguish those from biological effects is really challenging. Especially because much of the research up and including the early 2000s really have only focused on the presumed genetics side of things and together with the then hot human genome sequencing hype oversold a lot of things. Unfortunately these studies have also been very influential until now. 

That is not to say that genetics can be ignored, of course. There are for example certain alleles known now that have been associated with certain drug outcomes (such as undesired side effects or lack of efficacy). But the correct impact needs to be assessed in order to guide health responses.

[PhilGeis]

On 2/15/2021 at 9:24 AM, CharonY said:

They used zipcodes (to calculate neighborhood socio-economic status), insurance status as well as health factors. After adjustment the racial disparities for SES, the differences for infection likelihood vanished. It is much less likely that folks with lower SES are less culturally inclined to distance, but likely have a job which makes it difficult.

Thanks - I understand the potocoll.  Likely's seem pretty subjective.  "Much less likely" - on what basis is that assumption offered?   Certainly cultural differences have been reported in willingness to obtain vaccination.  If the nature of the job is a primary contributing factor - edvcuation rather than wealth per se would appear to be root cause.

[CharonY]

Just now, PhilGeis said:

Thanks - I understand the potocoll.  Likely's seem pretty subjective.  "Much less likely" - on what basis is that assumption offered?   Certainly cultural differences have been reported in willingness to obtain vaccination.  If the nature of the job is a primary contributing factor - edvcuation rather than wealth per se would appear to be root cause.

Oh no, this study did not look at cultural factors. The goal was to figure out the high death rates and found a strong association with a) being infected in the first place and b) a strong effect of SES.

Other studies have looked at reasons for higher infection rates among black and Hispanic folks and the conclusion from those is that it seems to be strongly correlated with jobs. 75% of frontline workers are POC, they are overrepresented in high-risk jobs such as meat factories and so on. While there might be cultural aspects, the economic ones (i.e. jobs) seem to explain most of the variance on their own, if looking at larger patterns. 

There are specific communities in which have high infection rates that could be based on cultural aspects, such as among orthodox Jews which appear overrepresented. But they tend to be pockets rather than larger patterns.

[PhilGeis]

On 2/23/2021 at 1:03 PM, CharonY said:

Oh no, this study did not look at cultural factors. The goal was to figure out the high death rates and found a strong association with a) being infected in the first place and b) a strong effect of SES.

Other studies have looked at reasons for higher infection rates among black and Hispanic folks and the conclusion from those is that it seems to be strongly correlated with jobs. 75% of frontline workers are POC, they are overrepresented in high-risk jobs such as meat factories and so on. While there might be cultural aspects, the economic ones (i.e. jobs) seem to explain most of the variance on their own, if looking at larger patterns. 

There are specific communities in which have high infection rates that could be based on cultural aspects, such as among orthodox Jews which appear overrepresented. But they tend to be pockets rather than larger patterns.

Yes - they did not look ar cultural factors - an unaddressed variable that confounds.  Dismissing this uncontrolled variable as "pockets"  orthodox Jews doesis not justified.   Jobs - then one would have to address unemployment as well - didn;t see that addressed here.    Appealing to economics is not justified - coincidence is not cause and "larger patterns" is a cop out. 

[CharonY]

2 hours ago, PhilGeis said:

Yes - they did not look ar cultural factors - an unaddressed variable that confounds.  Dismissing this uncontrolled variable as "pockets"  orthodox Jews doesis not justified.   Jobs - then one would have to address unemployment as well - didn;t see that addressed here.    Appealing to economics is not justified - coincidence is not cause and "larger patterns" is a cop out. 

Yes, fair enough, it was not part of the study but I am not sure what the hypothesis would be? E.g. that there are specific cultural groups within the racial groups that drive the higher infection rates? What specific groups could one meaningfully build to capture "culture" as a variable?

The study ultimately was aimed to see whether the higher death rate in Hispanic and black folks could be explained by higher infection rates (as there has been speculation of a biological basis) and the study indicates that if one simply adjust for being infected in the first place (which does correlate with socioeconomic factors) the survival rate is actually higher. I.e. major driver here seems to be socioeconomics and not race.