COVID-19 exposes inequality in New York City

In New York City, low-income and minority communities shoulder a disproportionate burden of COVID-19, with higher rates of hospitalisation and death.

The United States has been severely hit by COVID-19, with total confirmed cases forming about one-third of all global confirmed cases. New York City is the epicentre of the COVID-19 pandemic in the United States, with more than 15% of total cases nationally and accounting for 19,057 deaths (of 250,687 deaths worldwide).

Amidst the devastation wreaked across New York’s healthcare system, there are growing concerns that low-income communities and racial and ethnic minorities may be disproportionately shouldering the burden of the pandemic. A new study, led by researchers at Beth Israel Deaconess Medical Center and published in the Journal of the American Medical Association (JAMA), suggests that substantial differences in COVID-19-related hospitalisations and deaths have emerged along racial and socioeconomic lines in New York City.

Lead author Rishi K. Wadhera — an investigator at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and physician at BIDMC and Harvard Medical School — said that prior studies have shown disparities in health outcomes across New York City’s five boroughs: Brooklyn, the Bronx, Manhattan, Queens and Staten Island.

“We wanted to evaluate whether similar patterns have also emerged amid the COVID-19 pandemic,” Dr Wadhera said.

Using data from the U.S. Census Bureau and from the American Hospital Association, Wadhera and colleagues looked at population characteristics (eg, race/ethnicity), socioeconomic characteristics (median household income, poverty, education) and hospital bed capacity across the five boroughs. They then evaluated rates per 100,000 people of COVID-19 testing, COVID-19 patient hospitalisations and COVID-19-related deaths according to patients’ borough of residence based on data from the NYC Health Department, last updated on 25 April 2020.

The research team found that COVID-19 hospitalisation and death rates varied considerably across New York City boroughs. The Bronx — the borough with the highest proportion of racial and ethnic minorities, the most persons living in poverty and the lowest levels of educational attainment — had higher rates of hospitalisation and death related to COVID-19 than all other boroughs. In contrast, hospitalisation and death rates were lowest in Manhattan, the most affluent borough, which is composed of a predominantly white population. The number of COVID-19 deaths per 100,000 persons was nearly two times greater in the Bronx than in Manhattan.

“The substantial differences in COVID-19 death rates across New York City boroughs are concerning,” Dr Wadhera said.

“We need to understand the extent to which underlying comorbid illnesses, occupational exposure, socioeconomic determinants of health and race-based structural inequities explain the disparate outcomes among boroughs, to help shape ongoing public health strategies and policies that aim to mitigate and contain COVID-19.”

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