A health disparity is a difference in health outcomes between population groups, often seen as a higher burden of disease or mortality in one group. The COVID-19 pandemic brought these pre-existing inequities into sharp focus. The crisis did not create new vulnerabilities but instead exposed and amplified long-standing issues rooted in societal and economic structures. As a result, the patterns of infection and severity of illness followed existing lines of social and health disadvantages.
Populations Disproportionately Impacted
Data from the COVID-19 pandemic showed that certain demographic groups experienced a disproportionate burden of infection, hospitalization, and death. Racial and ethnic minorities, including Black, Hispanic/Latino, and American Indian/Alaska Native (AIAN) populations, faced worse outcomes. Age-adjusted data revealed that AIAN, Hispanic, and Black individuals were about twice as likely to die from COVID-19 as their White counterparts. These disparities often widened during viral surges and narrowed as overall infection rates declined.
Statistics from early in the pandemic highlighted these differences. Age-adjusted analyses showed that Hispanic people had hospitalization ratios up to 3.9 times higher than non-Hispanic White patients in some U.S. regions. Black populations also experienced higher rates of excess deaths than expected from pre-pandemic levels. For instance, Black individuals accounted for over half of the excess deaths in the under-25 age group during the public health emergency. Individuals with disabilities also faced heightened risks, although comprehensive data collection has been a challenge.
Underlying Socioeconomic Drivers
Underlying socioeconomic factors created higher-risk environments for certain populations. Occupational exposure played a significant role, as many racial and ethnic minority individuals are concentrated in essential, public-facing jobs that cannot be performed remotely. These roles in sectors like healthcare support, food service, and transportation involve more human interaction, increasing the likelihood of viral transmission.
Housing conditions further compounded these risks. Crowded, multi-generational households, more common in some communities due to economic pressures, make it difficult to isolate an infected family member and facilitate viral spread. Studies have shown a relationship between crowded living conditions and increased infection risk for respiratory illnesses, a pattern that held true for COVID-19.
Reliance on public transportation for commuting to essential jobs also increased exposure. For those without personal vehicles, crowded buses and trains became necessary points of potential transmission. These realities meant that for many, adhering to public health guidance like social distancing was a privilege not afforded by their circumstances.
Healthcare System Inequities
Inequities within the healthcare system created significant barriers to care during the pandemic. A lack of health insurance was a primary obstacle, with 2022 data showing higher uninsured rates among Hispanic (23%) and Black (11%) adults compared to White adults (7%). This can lead to delays in seeking care due to cost concerns, resulting in patients presenting at more severe stages of illness.
The geographic accessibility of healthcare facilities also played a part. Many low-income and minority communities are in “healthcare deserts,” with fewer hospitals, clinics, and testing sites, which meant residents faced greater difficulties getting tested and accessing treatments. For example, counties with higher poverty rates and larger Black or Hispanic populations often had fewer facilities to treat COVID-19.
Implicit bias and historical mistrust further complicated the healthcare experience. Concerns about receiving inequitable care can influence a person’s willingness to engage with the medical system. Studies show that bias can affect whether a patient receives proper testing and treatment even when access is available.
The Role of Pre-existing Health Conditions
A higher prevalence of pre-existing health conditions, or comorbidities, heightened the biological vulnerability of certain populations. Chronic illnesses such as diabetes, hypertension, obesity, and asthma were shown to increase the risk of developing severe COVID-19. The virus was found to be particularly dangerous for individuals with these conditions, often leading to complications like respiratory depression and multiple organ failure. For instance, the association between obesity and reduced lung function placed these individuals at greater risk.
These chronic conditions are not randomly distributed across the population. Their higher rates in Black, Hispanic, and AIAN communities are a product of long-term socioeconomic and systemic inequities. Factors including limited access to healthy food, the chronic stress of discrimination, and barriers to preventative healthcare contribute to the development of these diseases over a lifetime. The increased clinical severity of COVID-19 in these groups was therefore a physical manifestation of sustained social disadvantage.
The higher death rates from COVID-19 in some ethnic groups remained even after accounting for pre-existing conditions, indicating a complex interplay of factors. Still, the disproportionate burden of these underlying illnesses made certain communities more susceptible to the pandemic’s worst effects.