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Why Covid affects some communities more than others

Study sheds light on disparities in Massachusetts

(Image from the Harvard Gazette)

Massachusetts, September 4, 2020

Being a recent immigrant to the US, living in a household with many people, and working in the food service industry appear to be among the top drivers of high Covid-19 case rates in Latino communities in Massachusetts, according to a new Study from researchers at Harvard T H Chan School of Public Health.

Influencing factors

The Study, published August 27, 2020 in Health Affairs, also looked for factors linked with high Covid-19 case rates among Black residents, but did not find clear answers.

Possible explanations could be disproportionately high incarceration rates, living in multiunit residential buildings with high population density, and greater use of public transportation to get to work, said Study lead author Jose Figueroa, Assistant Professor Of Health Policy and Management, in a STAT article.

“We really need to try to understand all of this structural discrimination,” he said.

The Study quantified Covid-19 cases from Massachusetts’ 351 cities and towns.

Researchers found that a 10 percentage point increase in the Black population of a community was associated with an increase of 312 Covid-19 cases per 100,000 people, while a 10 percentage point increase in the Latino population was linked with an increase of 258 cases per 100,000.

“We knew that these communities were being hit harder, and the question was, how much more,” Figueroa said in a Boston Globe article.

“We can now put a number to the burden on these Latino and Black communities. And it is significant,” he said.

An extract from the Study

Across Massachusetts’ cities and towns, Latino and Black communities are experiencing much higher rates of Covid-19 cases.

Several factors measured in the data (foreign-born non-citizen status, household size, and job type) appear to explain the higher Covid-19 case rates among Latino communities in Massachusetts.

It appears that these factors may not be the primary reason for higher case rates in Black communities.

While the extent of racial and ethnic disparities has already been documented, the Study identifies important factors that are independently associated with higher Covid-19 case rates in the State.

The proportion of foreign-born non-citizens was the strongest predictor of the burden of Covid-19 cases within a community, and in Massachusetts, this population includes sizable numbers of both Latin American (44.9%) and Asian individuals (30.7%).

Furthermore, under the Trump Administration’s revised “Public Charge” Rule, which took effect in early 2020, lawfully present immigrants who use public benefits from local, state, or federal governments may be at risk of being denied permanent residency status.

Insurance for migrant population

Although the US Citizenship and Immigration Services website now encourages immigrants to seek care for Covid-19 like symptoms, enrolment in Medicaid at the time of Covid-19-related care may still be used in the Public Charge analysis.

Recent studies suggest that immigrant families have strong incentives not to enrol in public health insurance like Medicaid and may avoid seeking medical care if they develop Covid-19 like symptoms and require testing.

In the absence of a positive test, these individuals are less likely to isolate and quarantine, which may impede public health efforts to control the spread of COVID-19.

These issues are likely only magnified by the fact that immigrants tend to live in larger households, which we also found to be an independent predictor of Covid-19 case rates.

Policy approaches that reduce barriers to accessing medical care for immigrant populations and that address crowded housing, particularly when individuals have tested positive and need to be isolated, could be important avenues for reducing disparities and slowing the spread of infection.

Other Harvard Chan authors of the Study included research assistant Dennis Lee and Benjamin Sommers, Huntley Quelch Professor of Health Care Economics.

Read the STAT article: Immigration status, housing, and food-service work explain Covid-19’s burden on Latinos

Read the Boston Globe article: New Study confirms staggering racial disparities in COVID-19 cases in Massachusetts

The above article and picture appeared in The Harvard Gazette.

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