Early in the COVID-19 pandemic, a pattern emerged: the virus did not affect all communities equally. “COVID-19 racial disparities” refers to the differences in infection, hospitalization, and death rates among various racial and ethnic groups. These inequities are not the result of inherent biological or genetic predispositions. Instead, they are rooted in long-standing societal factors that created different living and working conditions for different groups, highlighting pre-existing vulnerabilities.
Disproportionate Rates of Infection and Severe Disease
Data from the Centers for Disease Control and Prevention (CDC), when adjusted for age, revealed that certain racial and ethnic groups faced a higher burden. Age-adjusted data showed that Native Hawaiian and other Pacific Islander, Hispanic, and American Indian or Alaska Native (AIAN) people were about one and a half times more likely to be infected with COVID-19 than White people.
The disparities were more pronounced for severe outcomes. The CDC reported differences in COVID-19 hospitalizations for AIAN, Black, and Hispanic individuals. The risk of death was also unequally distributed, with AIAN, Hispanic, Native Hawaiian and other Pacific Islander, and Black individuals approximately twice as likely to die from COVID-19 as their White counterparts.
During the initial waves of the pandemic, these gaps were particularly wide. For instance, in July 2020, Hispanic individuals were five times more likely to die from COVID-19 than White individuals. At that same time, AIAN and Black people were roughly four and three times as likely to die, respectively. Cumulative data throughout the pandemic establishes a consistent pattern of disproportionate suffering.
Drivers of Exposure Risk
The higher infection rates among specific racial and ethnic groups are linked to societal factors that increase the probability of encountering the virus. A primary driver was occupation, as many individuals from minority groups are overrepresented in essential, frontline jobs that cannot be performed remotely. These roles in public transit, grocery stores, agriculture, and healthcare support involve high levels of public interaction, making physical distancing difficult and placing them in direct contact with the virus daily.
Living conditions also played a part in elevating exposure risk. Densely populated neighborhoods and multigenerational households, more common in some minority communities, can facilitate the rapid transmission of an airborne virus. In crowded living situations, such as on some tribal reservations, isolating an infected family member is often impractical, leading to household clusters of infection.
A greater reliance on public transportation for commuting also created another avenue for increased exposure. Buses and trains bring many people into close, prolonged contact in enclosed spaces, heightening the risk of transmission. For communities where public transit is the primary mode of transportation, this daily necessity became a risk factor for contracting COVID-19.
Factors Worsening Health Outcomes
Once infected, other factors influenced the severity of the illness. A higher prevalence of underlying medical conditions, or comorbidities, in Black, Hispanic, and AIAN populations worsened COVID-19 outcomes. These conditions, including diabetes, hypertension, and heart disease, are often linked to social determinants of health. Limited access to nutritious food, exposure to pollution, and chronic stress from discrimination contribute to these health problems.
Inequities in the healthcare system created barriers to receiving timely care. Individuals from minority groups are more likely to be uninsured or underinsured, making them less likely to seek care due to cost. In 2022, about 23% of Hispanic adults and 11% of Black adults were uninsured, compared to approximately 7% of non-Hispanic White adults.
The quality of care is also affected by where a person lives. Hospitals in predominantly minority communities are often under-resourced, meaning fewer ICU beds and less access to advanced treatments. Additionally, implicit bias among providers and medical mistrust stemming from historical discrimination can impact patient-provider communication and the quality of care delivered.
Systemic Roots of Health Inequity
The factors driving higher exposure rates and more severe outcomes are not coincidental. They are symptoms of deeper, systemic inequities that created the conditions for the pandemic’s unequal impact. This demonstrates how racism, not race itself, drives health disparities.
Historical policies have played a direct role in shaping present-day health. For example, residential segregation, enforced through practices like redlining, concentrated minority populations into specific neighborhoods. These areas have often been subject to disinvestment, leading to poorer housing, higher pollution, and limited access to resources like quality schools and grocery stores with fresh food.
This geographic and economic stratification has had cascading effects on health. Limited educational and economic opportunities resulted in a racial wealth gap, which restricts access to stable housing, nutritious food, and quality healthcare. The chronic stress from experiencing discrimination has also been linked to a higher burden of diseases like hypertension. The COVID-19 pandemic did not create these inequalities; it exposed and amplified them.