Increased Incidence and Mortality of COVID-19 among the U.S. Socially Vulnerable Population: Findings From the Early Phase of the Pandemic Ibraheem M. Karaye, MD, DrPH, Assistant Professor, Department of Health Professions, School of Health Professions and Human Services, Hofstra University INTRODUCTION The increased incidence and mortality rate of COVID-19 among minority populations in the U.S., particularly African Americans, has captivated significant public attention (Calma, 2020b; Collins, 2020; Eligon et al., 2020). An analysis of available data has shown that African Americans are three times more likely to contract COVID-19 and six times more likely to die from the disease than whites (Thebault, Tran, & Williams, 2020). For example, in Houston, Texas, where African Americans comprise 22.5% of the population, they make up 57% of deaths due to COVID-19 (Bludau, 2020). In Milwaukee, Wisconsin, African Americans 16
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constitute 26% of the population but account for 70% of COVID-19-related deaths (Thebault, Tran, & Williams, 2020). In Louisiana, 70% of deaths from the disease are among African Americans, although they constitute only 32% of the state’s population (Thebault, Tran, & Williams, 2020). Traditionally marginalized populations like racial minorities, persons with disability, the elderly, those living in poverty, and undocumented immigrants have historically borne the brunt of the health impacts of disasters because social factors predispose them to poor health outcomes (Karaye, Ross, & Horney, 2019; Palaiologou et al., 2019;
Rufat et al., 2015). For example, low socioeconomic status is associated with low per capita income, uninsured medical status, and poor access to health care, which may collectively increase the risk of adverse outcomes (Calma, 2020a; Calma, 2020b; Collins, Bhupal, & Doty, 2019; Galea, 2020; Link, 2008; U.S. Department of Health and Human Services (U.S. DHHS), 2019). Specific to COVID-19, residential overcrowding, lack of workplace protections, and inability to telework may limit adherence to physical distancing guidelines among socially vulnerable groups (Perry, Rothwell, & Harshbarger, 2018; Ray, 2020). Poor environmental conditions from historically racial-structured