Social Determinants of Health, Comorbidities Sway COVID-19 Severity

Social Determinants of Health, Comorbidities Sway COVID-19 Severity

A non-elderly adult patient with comorbidities and has contracted the novel coronavirus has a one-in-five chance of seeing those symptoms become severe. Those odds are difficult, but could be even worse if the patient is a person of color or has a low income, according to new data about the social determinants of health from the Kaiser Family Foundation.


While most patients who have COVID-19 are expected to recover well, there is a long-identified cohort of patients who could fare far worse. Previous data from KFF showed that non-elderly adult patients who are deemed high risk — meaning they have heart disease, COPD, uncontrolled asthma, diabetes, or a body mass index (BMI) greater than 40 — who get the disease are more likely to experience exacerbated symptoms.


Specifically, 21 percent of those high-risk patients will suffer serious COVID-19 symptoms, the April report said.


This latest data, which leaned on demographic information from 2018, found that those odds could be worse for communities of color and those who are low-income, likely because of the social determinants of health they see.


American Indian and Alaska Native patients who contract the coronavirus are expected to suffer a far worse fate than their white peers, with 34 percent of this population likely to get extremely sick should they contract the virus.


Black patients (27 percent) and Native Hawaiian or Pacific Islander patients (23 percent) are also expected to get sicker with COVID-19 than their white peers, 21 percent of whom would be expected to face extreme coronavirus illness.


Meanwhile, 20 percent of Hispanic patients and 12 percent of Asian patients with comorbid would fall seriously ill if they contracted the virus.


“Even though the shares of Hispanic and Native Hawaiian or Pacific Islander nonelderly adults at higher risk for serious illness if infected are similar to that of White adults, these groups face disparities in other health, social, and economic factors that may contribute to barriers to health care associated with coronavirus,” the researchers explained.


“Although our analysis finds Asian adults are the least likely to be at higher risk for serious illness, this finding may mask subgroups of Asian adults who may be at higher risk.”


Disparities in serious COVID-19 symptoms for comorbid patients are also present by income. Regardless of race, patients with lower incomes have a higher risk of having more severe COVID-19 symptoms than those in high-income households.


Thirty-five percent of comorbid and coronavirus-positive patients living in a household with $15,000 in annual income or less would see exacerbated symptoms, the data shows. Similar patients in households with income between $15,000 and $25,000 annually are also more likely to see severe symptoms (30 percent).


Numbers level off for patients with incomes between $25,000 and $35,000 (21 percent) or $35,000 and $50,000 (21 percent).


Those making more than $50,000 face a below-average risk of developing severe COVID-19 symptoms, with only 16 percent likely to see such exacerbation.


“This is principally because of underlying health conditions that are more prevalent among non-elderly adults with low incomes,” the researchers said.


It may also be tied to employment opportunities, they added.


“People with low incomes who work in jobs such as grocery story workers, delivery drivers or home health aides that are defined as essential may put themselves at higher risk of contracting coronavirus than others who are able to shelter in place and follow guidelines for social distancing,” the report stated.


This data raises concerns about healthcare access and affordability, KFF asserted. Individuals who are low-income are less likely to have health payer coverage than high-income earners.


Recent legislation has aimed to provide funds to healthcare organizations treating uninsured COVID-19 patients. But there is a large number of providers who qualify for these payments, meaning the fund could quickly run out, “raising questions about coverage for the uninsured, and the costs of their care when such funds are no longer available,” the report authors said.


This data comes as the healthcare industry has called for better data and reporting about coronavirus outcomes and mortality stratified by race. Such data is intended to help healthcare professionals better target their efforts based on need.




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