Two unique trends have emerged in recent months: For the first time in the pandemic, the U.S. Covid-19 case rate is higher among Asians, and the death rate among whites is higher than any other racial or ethnic group. .
These trends are a dramatic shift among groups that data show is doing better during the pandemic. But experts say there are serious limitations in federal data that mask persistent inequalities.
“Although we’ve eliminated some of the large disparities we saw earlier, there are still persistent disparities in several areas,” said Dr. Sarita Shah, a clinical care provider and infectious disease epidemiologist at Emory University. We’ve come a long way because we identified these issues early on. But I want to emphasize that we still see gaps that really reflect the underlying systemic deficiencies in many areas that are affecting people of color and minorities The impact of ancestry is particularly severe. »
First, federal data is very incomplete. Race and ethnicity are missing in more than a third of cases and one in seven deaths, according to the U.S. Centers for Disease Control and Prevention.
“If you just look at national data, you’re going to kill everything and fail to understand the story of the epidemic that’s actually happening in different communities,” said Stefanie Friedhoff, a researcher and director of the Brown University School of Public Health.
Missing data may also be biased towards underrepresented populations — people with language barriers that may not communicate their race or ethnicity, said Dr. /o Community Health Associations.
This could lead to “conclusions drawn from population samples that may not even reflect the real phenomenon of what is going on,” he said.
Second, age adjustment is important. Life expectancy and age distributions vary by race and ethnicity, and age adjustments are normalized for this difference.
According to the CDC, “Adjusting for age is important because the risk of infection, hospitalization, and death varies by age, and the age distribution varies by race and ethnicity.”
In the first week of May, the most recent week for which complete data are available, whites 75 and older had the highest death rates. But blacks and Hispanics still have the highest death rates for those aged 50 to 74, according to the CDC.
For all racial and ethnic groups, recent death rates are at or near their lowest levels since the pandemic. While whites currently have the highest death rate, the magnitude of the disparity is far less than the inequality that persists during the vast majority of the pandemic.
Even among those 75 and older, there were 2.3 deaths per 100,000 white people and 1.7 deaths per 100,000 black or Hispanic people. But at the peak of the Omicron push, when the balance was tilted, 92 deaths per 100,000 Hispanics, 55 per 100,000 blacks and 35 per 100,000 whites.
Overall, the CDC’s age-adjusted data from the onset of the pandemic show that blacks, Hispanics and Native Americans are still about twice as likely to die from Covid-19 as whites.
Still, important distinctions remain between the major racial and ethnic groups used by the CDC to present the data.
Age-adjusted data showed that Asians had the lowest risk of infection, hospitalization or death, even lower than the risk of whites.
But the finding is rooted in “a mutually reinforcing cycle of poor Asian-American data infrastructure,” Oronce said, citing the work of NYU epidemiologist and researcher Stella Yi.
Asian-Americans are seen as monolithic and stereotyped as a model minority, he said. But this perception of high-performing groups with no health problems “makes these subsurface differences invisible.”
Certain groups within this broad Asian racial category have been hit especially hard by Covid — notably Hawaiians and Pacific Islanders, as well as Filipinos.
Federal mandate to classify data on Native Hawaiians and Pacific Islanders. But because the CDC compiles data collected by states, it doesn’t always include this distinction.
UCLA’s Native Hawaiian and Pacific Islander Data Policy Lab collected and analyzed Covid-19 data from the states that provided it and found that Native Hawaiians and Pacific Islanders had three times as many cases and deaths as those states For the average Asian.
“Our community has the highest case and death rates of any other racial or ethnic group,” said project leader ‘Alisi Tulua, a gap that has “widened significantly” since this winter.
But she said the hidden data made it difficult to identify risks and the need to continue taking precautions.
“It’s worrying that we can’t even prove it to our own people. »
The drivers behind the trend change
Although some groups felt overburdened by the disease from the start, this is the first time it has been seen in Asians.
Experts say this is the result of a combination of risk factors.
About a quarter of Asians in the U.S. live in multigenerational households, many of whom work in the health care industry.
The rise in case rates “reflects social and occupational risks that can disproportionately impact Asian American communities,” said John Nguyen-Yap, associate director of health equity at the Asian Association of Community Health Organizations. Pacific Ocean. .
Language barriers are also a challenge, he said, exacerbating every step of the process, whether it’s communicating about available tests, how to minimise risk, or how and why to get vaccinated.
More generally, experts say it’s more important to focus on the local than to track changes in national aggregated data.
“We have these persistent, mostly localized disparities, and the reality is a lot more grim than what we’re seeing nationally,” Friedhoff said. Sometimes “even a zip code can be a huge Framework. You look at the blocks and you will see these differences. »
For example, the Houston researchers found “large differences” even among the African diaspora in the United States. In Chicago, there is a 50 percent difference in vaccination rates between the North and South Sides, she said.
Immunization rates in particular represent evidence of the underlying structural problems that have contributed to the inequities that have persisted throughout the pandemic, and evidence of the disparities that health equity advocates have worked tirelessly to achieve, experts say.
“We’re seeing the same issues of vaccine equity that we’re seeing with tests and treatments,” Friedhoff said. “Since vaccines are really our best first responders, if we can immunize equitably, they can close the gap.”
Whites are more likely to be vaccinated earlier, but that gap has narrowed significantly, which may help close the mortality gap that has been highlighted in recent trends.
Many groups have made “tremendous progress” in addressing vaccine misinformation and barriers to accessing vaccines in underserved and high-risk groups, but not much has changed among the white population, Shah said. Some groups could still benefit from targeted outreach, including some white people in rural areas.
According to the CDC, vaccination rates for all races and ethnicities now surpass that of whites, with one exception: About 43 percent of blacks are fully vaccinated, compared with 49 percent of whites.
According to the latest data from the CDC, unvaccinated people are 10 times more likely to die from Covid-19 than fully vaccinated people.
Either way, Friedhoff said, with Covid-19, “either or the other” doesn’t matter.
“I just want us to focus on who is dying and how we can prevent people from dying. »