Immunology

COVID-19, health disparities, and what the allergist-immunologist can do



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Key words

The COVID-19 pandemic has laid bare the inequities in health care and has highlighted the need for greater attention to overcoming the structures, systems, and beliefs that contribute to health disparities through inequities in social determinants of health (SDOHs). The SDOHs are the conditions in the environments in which people are born, live, learn, work, play, worship, and age and which influence health, quality of life, outcomes, and risk (Fig 1). Understanding the SDOH context is important for addressing the many COVID-19–related questions that our patients have. These questions range from vaccine-related concerns to understanding COVID-19 risk for people with asthma to understanding and managing risk for people with immune deficiency to environmental controls (ventilation and filtration). We are not fully equipped to engage with patients and their families on these issues without an appreciation of the social needs of the family and how those social needs shape actual risk, risk perception, resources available, and trust. In this review, we will discuss how the COVID-19 pandemic has affected health disparities through the lens of SDOHs.

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Fig 1Social determinants of health (SDOHs). SDOHs are social conditions that affect the health and well-being of persons. They can be protective or detrimental to health and some are modifiable. Health disparities refer to modifiable factors that are unequally and unfairly distributed among different population groups. As an example, economic instability leads to poverty and housing instability.

Adapted from Healthy People 2030 from the Office of Disease Prevention and Health Promotion, US Department of Health & Human Services, Washington DC.

Health and health care

The COVID-19 pandemic has devastated the world, with a total of 179,258,465 recorded cases and 3,884,494 deaths globally (as of June 23, 2021). In the United States, overall COVID-19 case numbers have exceeded 38 million since the start of the pandemic. When we look specifically at COVID-19 cases and outcomes among racial and ethnic minority populations, we see that Latinx, Black or African American, and American Indian or Alaskan Native persons have more than twice the number of hospitalizations and deaths compared with non-Hispanic White persons. The factors that contribute to increased risk of infection include the fact that minority patients are disproportionately represented in essential worker and service positions, with less ability to engage in risk-mitigating behaviors such as working from home or socially distancing.

  • Figueroa J.F.
  • Wadhera R.K.
  • Lee D.
  • Yeh R.W.
  • Sommers B.D.
Community-level factors associated with racial and ethnic disparities in COVID-19 rates in Massachusetts.