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Is higher COVID-19 mortality in Black adults linked to essential work?

A new study finds that performing many low paid but essential jobs puts people at higher risk of SARS-CoV-2 infection. It also finds that Black people in the United States are more likely to have these higher risk jobs. This could expose them disproportionately to a higher risk of infection.

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Black people in the U.S. who perform essential work may have a higher risk of mortality from COVID-19.

The research, which took place at the University of Utah in Salt Lake City, reveals that non-Hispanic Black people were more likely than non-Hispanic white people to hold occupations considered essential, meaning that they continued to work during state lockdowns.

The team collected data on COVID-19 deaths between April 9 and April 24, 2020. At that time, a total of 35 states and the District of Columbia published the number of deaths by racial group.

This analysis adds to existing evidence that suggests higher COVID-19 mortality rates among non-Hispanic Black people.

In Wisconsin, for example, the new study suggests that non-Hispanic Black people accounted for 36% of all COVID-19 deaths, despite making up only 6% of the state’s population.

However, the analysis also demonstrates that non-Hispanic Black people were more likely to be working in most of the essential occupations. This likely put them at higher risk of infection and made it more likely that they would pass the virus to other members of their household.

The research appears as an invited article in a special issue of the journal World Medical & Health Policy.

The researchers used data from the Current Population Survey to determine the prevalence of 22 occupational categories within each racial group in the 35 states and the District of Columbia.

In descending order, the five occupations with the greatest overall preponderance of non-Hispanic Black workers compared with non-Hispanic white workers were:

  • transportation and material moving
  • healthcare support
  • food preparation and serving
  • building and grounds cleaning and maintenance
  • personal care and service

The study shows that 4 out of 5 of these were in the top third of positive correlations between employment and the percentage of COVID-19 deaths across all states and racial groups.

The fifth was “building and grounds cleaning and maintenance,” which still had a positive and statistically significant correlation but was not as strong as that of other jobs. Presumably, since much of this work is outdoors, the risk was slightly lower.

“There are a lot of theories [as to why Black people] are dying at higher rates than [people of] other races during this pandemic,” says senior study author Fares Qeadan, Ph.D.

Black adults, he explains, are overall likely to be “working in jobs where they have a greater risk of coming [into] contact with the virus day in and day out.”

The study authors conclude:

“Existing structural injustices will continue to shape racial disparities in this pandemic if essential workers are treated as expendable, and unless companies and governmental leaders prioritize workplace safety and protection as a matter of public health.”

Tiffany Green, an assistant professor in the Departments of Population Health Sciences and Obstetrics and Gynecology at the University of Wisconsin-Madison, has pointed out that physical distancing is difficult to achieve in some essential occupations and while using public transport.

In addition, many employers do not provide adequate health insurance, if any.

Speaking about the issue to Medical News Today in May 2020, she said: “All of this is to say that we are asking low paid workers to take on an enormous amount of risk with little reward.”

“Yet, many are forced to continue working — often without proper personal protective equipment — because without these jobs, they cannot feed themselves or their families (who are also now at greater risk).”

A review of scientific evidence by Public Health England reached similar conclusions about the disproportionate impact of the pandemic on Black individuals in England.

The review suggests that Black people had the highest age-standardized diagnosis rates for COVID-19 of any racial group. It also concludes that working in essential occupations with a high risk of exposure and using public transport may be contributory factors.

However, the authors caution that the presence of preexisting medical conditions is also likely to play an important role in increased COVID-19 mortality.

“Other evidence has shown that when comorbidities are included, the difference in risk of death between ethnic groups among hospitalized patients is greatly reduced,” they write.

The authors of the new study concede that their analysis was purely descriptive. It establishes a correlation but not a causal association between employment in most essential occupations and increased COVID-19 mortality.

They also demonstrate that non-Hispanic Black people are more likely to be employed in these essential occupations.

They write that it was beyond the scope of the study to investigate the connections between race and other health conditions and how these connections might affect the impact of occupation on the risk of death from COVID-19.

Studies such as these highlight the importance of collecting health data by race. As Green said, this is an issue of civil rights law, which starts with collecting the right data.

In May, she told MNT: “As legal scholar Ruqaiijah Yearby brilliantly points out, the federal government must aggressively enforce existing civil rights laws by:

  1. Collecting data on COVID-19 morbidity and mortality by race and ethnicity.
  2. Investigating healthcare systems and providers suspected of racial bias in healthcare (whether unintentional or not).
  3. Imposing fines where necessary for violations. Enforcing civil rights laws in education, housing, and employment is just as critical as addressing those in healthcare, as those factors arguably have an even greater impact on the health and well-being of [people of color].”

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