From the Guidelines
Underserved populations in the United States experienced higher COVID-19 mortality rates due to multiple interconnected factors, including structural inequities, limited healthcare access, and higher prevalence of underlying health conditions, as evident in the study by 1. These populations often have higher prevalence of underlying health conditions like diabetes, hypertension, and obesity that increase COVID-19 severity.
- Housing density and overcrowding made social distancing impossible for many, while employment in essential frontline jobs without remote work options increased exposure risk, as noted in the study by 1.
- Transportation barriers prevented many from accessing testing and treatment.
- Language barriers and health literacy challenges complicated understanding of prevention measures and when to seek care. Additionally, systemic racism contributed to disparities in healthcare quality and treatment decisions, as highlighted in the study by 1.
- Food insecurity and limited access to nutritious foods weakened immune response capabilities.
- Finally, vaccine hesitancy and access issues in these communities delayed protective immunization, particularly early in the pandemic when vaccines could have prevented many deaths, as discussed in the study by 1. The study by 1 emphasizes the importance of recognizing racial, ethnic, and socioeconomic disparities that may influence the risk for adverse outcomes, including mortality, in COVID-19. The reasons behind these disparities are multifactorial, including higher exposure risk, higher prevalence of CV risk factors and disease, and limited healthcare accessibility, as explained in the study by 1. Therefore, addressing these disparities is crucial to reducing COVID-19 mortality rates among underserved populations. The study by 1 highlights the importance of considering age and comorbidities in COVID-19 patients, as these factors are strong predictors of hospitalization, critical illness, and mortality. Overall, the evidence suggests that a comprehensive approach is needed to address the complex factors contributing to higher COVID-19 mortality rates among underserved populations, including improving healthcare access, addressing social determinants of health, and promoting vaccine equity, as discussed in the studies by 1.
From the Research
Factors Contributing to Increased COVID-19 Mortality
The COVID-19 pandemic has disproportionately affected underserved populations in the United States, resulting in increased mortality rates among these groups. Several factors contribute to this disparity, including:
- Societal and cultural barriers to achieving health equity, which are systemic issues that can only be addressed through shifts in governmental policies 2
- Limited access to social services and healthcare, particularly in underserved communities living in poverty 2, 3
- Pre-existing social determinants of health, such as population density, epidemiological and healthcare system factors, which play a significant role in determining COVID-19 outcomes for communities of color 3
- Urban and rural disparities in COVID-19 outcomes, with urban areas experiencing higher mortality rates in 2020 and rural areas seeing increased cases and mixed hospitalization results in 2021 4
Vulnerable Populations
Certain populations are more vulnerable to COVID-19-related mortality, including:
- Racially and ethnically minoritized populations, who experience exacerbated disparities in rural regions 4
- Older adults, who are at higher risk of severe illness and death from COVID-19 4, 5
- Individuals with comorbidities, who are more likely to experience severe illness and death from COVID-19 2, 6
- Those with lower socioeconomic status and vaccination rates, who are more likely to experience poor health outcomes from COVID-19 4, 5
Healthcare Infrastructure and Access
Healthcare infrastructure and access play a critical role in determining COVID-19 outcomes, with: