Young people of color with preexisting conditions face elevated COVID-19 risk

Age-adjusted hospitalization rates are highest among minorities.

By Laura Romero and Dr. Jay Bhatt
This article was originally posted on abcnews.com on July 15, 2020.

Communities of color have been bearing the brunt of the coronavirus since the pandemic began, and as multiple states across the country are seeing record-breaking spikes in COVID-19 cases, doctors are seeing a new trend: Young people of color with underlying medical conditions are being hit harder by the virus than their peers.

People of any age with preexisting conditions, like diabetes, obesity and heart disease, are at an increased risk of severe illness from COVID-19 because of the effect those conditions have on a person’s immune system. Data released by the Centers for Disease Control and Prevention in May showed that COVID-19 patients with those same preexisting conditions are more likely to need treatment in a hospital — or even in an intensive care unit.

But for younger people of color, who are more likely to experience chronic health conditions associated with poor outcomes from COVID-19 at higher rates, the reality is particularly grim.

You combine long-standing health inequities and a health system with essential worker status and with underlying conditions, it is a perfect storm for a population we really need to look out for,” said Dr. Atul Nakhasi, a primary care physician and policy adviser at the Department of Health Services in Los Angeles, the nation’s second-largest health system that serves a low-income area.

As of mid-June, age-adjusted hospitalization rates released by the CDC were highest among non-Hispanic American Indian or Alaska Native and non-Hispanic Black persons, followed by Hispanic or Latino persons, suggesting minority groups regardless of age have higher rates of hospitalization or death from COVID-19 than non-Hispanic white persons.

A recent ABC News state review found that while the majority of hospitalized patients remain older Americans, and nationally the death rate in the younger age group remains extremely low, several state and hospital officials across the nation are increasingly reporting that young people are not just contracting the virus, they are getting sick.

And because several states across the nation are seeing more and more youths come through hospital doors, it’s people of color with underlying conditions who are at an increased risk of getting the novel coronavirus and experiencing severe illness.

For Latinos, who already bear a disproportionate share of coronavirus cases, the data is particularly alarming since they are among the youngest racial or ethnic groups in the U.S., according to a study from Pew Research Center.

Several experts told ABC News that the issue stems from the link between health and wealth in the United States.

Dr. Matthew G. Heinz, a hospitalist (hospital physician) and internist in Tucson, Arizona, who said he has been admitting younger patients at an alarming rate, said that health and social inequities are putting younger minorities at higher risk.

I think a lot of it could derive from decades long of leftover health disparities,” said Heinz. “Just a lack of consistent access to good primary care, medical care, regular checkups. When you lack that as a population, you will see a lot of underlying medical conditions which makes you ever so much more attractive to COVID. It loves diabetic, obese, hypertensive patients.

In an analysis of data released by the state’s Department of Health, Florida Today found that as of early May, of the 25 people age 40 or younger who had died from the coronavirus in Florida, most suffered from asthma, chronic bronchitis, morbid obesity and hypertension — conditions that disproportionately affect people of color.

These underlying medical conditions are highly prevalent in low-income Americans, according to a study released by the Robert Wood Johnson Foundation. In 2018, Hispanic/Latino Americans accounted for 19% of total people living in poverty in the U.S., Black Americans accounted for 22% and Asian/Native Hawaiian and Pacific Islander accounted for 11%, according to the Kaiser Family Foundation.

Dr. Rhea Boyd, a pediatrician at the Palo Alto Medical Foundation Clinic in California, said many of those preexisting conditions are driven by the social conditions.

Some of the structural factors are like environmental racism because of residential segregation and zoning ordinances,” Boyd told ABC News. “These populations are also disproportionately exposed to toxins and pollutants. And studies show that chronic exposure to air pollution increases COVID-19 mortality rate.

Nakhasi said improving access to health care for minorities should be a priority.

We have a long way to go in this country to improve health inequities and health care access to underserved communities, low-income communities, urban communities,” Nakhasi told ABC News. “If it’s harder to show up to the doctor, if it’s harder to build that rapport to your primary care physician, if it’s harder to get health care, access and insurance, it’s going to be harder to to diagnose you and treat you effectively, quickly and efficiently.

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