Although anyone can catch the novel coronavirus, we’ve known for months that not everyone is equally at risk of dying or becoming seriously ill from COVID-19. But it’s not just older people who are vulnerable. Preliminary reports on COVID-19 fatalities suggest black Americans are dying at elevated rates, and poorer Americans are many of the workers whose jobs put them at daily risk of exposure.
And the medical conditions that make the coronavirus more dangerous aren’t evenly distributed throughout the population. The Centers for Disease Control and Prevention says that anyone who has underlying conditions that compromise their immune system or other ailments like heart disease or diabetes is also at increased risk. A recent report from the CDC found that as of March 28, only about half of all patients hospitalized with COVID-19 were over 65, while three-quarters of hospitalized patients of all ages had at least one underlying condition.
We analyzed the CDC’s 2018 Behavioral Risk Factor Surveillance System data, a collection of health-related surveys of U.S. residents, to see just how many Americans are more vulnerable to getting seriously ill from COVID-19 and what demographic groups they fall into.list of the relevant underlying conditions and the advice of experts from the Cleveland Clinic, the American Lung Association and the American Heart Association, we included in our analysis respondents who have ever been told they have coronary heart disease, a myocardial infarction, angina, a stroke, chronic obstructive pulmonary disease, emphysema, chronic bronchitis, chronic kidney disease or diabetes; those who currently receive cancer treatments or have asthma or a BMI over 40; those who smoke cigarettes every day or some days, use e-cigarettes or vaping products every day or some days, or have smoked, vaped or dabbed marijuana in the last 30 days; and women who are currently pregnant. We included every individual who meets at least one of these conditions but counted them only once each, so anyone with multiple conditions doesn’t get counted multiple times. There are conditions we were not able to include as they were not specifically asked about, such as hypertension, liver disease, AIDS or other immunosuppressive illnesses, and those who are on immunosuppression medications such as transplant patients.">1 Some of the most striking findings:
According to the data, more than 135 million American adults, or 52 percent, are somehow at elevated risk.
- About three-fifths of those who are vulnerable are under 65.
- Younger black Americans are more likely to be vulnerable. The percentage of white Americans who are over 65 is higher than the share of black Americans in that age group, but among those under 65, a larger percentage of black Americans have underlying conditions.
- The poorest and least educated Americans are more likely to be at risk than those with higher incomes or more education. More than 60 percent of those who make less than $25,000 a year and those who did not complete high school have an underlying condition that makes them vulnerable.
So to better understand the threat Americans are confronting, let’s dive deeper into the data.
2 in 5 younger people are at elevated risk
Although everyone over 65 is considered to be at higher risk whether or not they have underlying conditions, as you can see in the chart below, more than 30 percent of every age group is at risk. Overall, nearly 40 percent of all Americans under 65 have a condition that makes COVID-19 more dangerous for them.
Similar percentages of white and black Americans are at high risk (56 percent and 54 percent, respectively), but white Americans are more likely than other racial groups to be at risk because of their age, as you can see below. Some of the most at-risk groups are multiracial and black Americans under 65.
The pandemic preys on existing inequalities
David Williams, a professor at Harvard’s T. H. Chan School of Public Health who studies how social factors like race and socioeconomic status affect health, said that people of color are more likely to develop conditions like heart disease and diabetes than white Americans, and to develop those conditions at a younger age than white people do.
These disparities extend to whether people are getting regular health care, too. For example, the CDC’s risk factor survey estimates that almost 16 percent of black Americans — 4.8 million people in total — did not see a doctor when they needed one at some point in the 12 months prior to taking the survey because they couldn’t afford to go. Among Latinos, that number jumped to almost 20 percent, while around 17 percent of Native Americans and multiracial Americans reported forgoing needed care. In contrast, 10 percent of whites and 9 percent of Asian Americans didn’t see a doctor because of cost concerns. And that makes sense, because black Americans were also almost twice as likely to lack health insurance as white Americans, and Hispanic Americans were nearly four times as likely.
The reasons for these disparities are well documented. Pervasive residential segregation puts people of color at a disadvantage, differences in employment and education opportunities exacerbate poverty, communities of color have fewer health resources and less access to fresh food, and for decades, alcohol, tobacco and junk food companies have targeted advertising to black and Hispanic communities.
Williams also pointed to a comprehensive study of how people of color experience the health care system. The study suggested that at least partly due to providers’ implicit bias, black, Hispanic and Native American patients can receive lower quality health care.
“The science is 100 percent clear on this point and that is, across virtually every therapeutic intervention in the United States, from the most simple procedure to the most complicated, blacks and other minorities receive poorer quality care and less intensive care than whites,” he said.
The working class faces higher risk
Because of how race and class are intertwined in American life, you can also see health inequalities along socioeconomic lines. In general, Williams said, “Socioeconomic status is one of the biggest predictors of variations in health in the world.” Almost two-thirds of those who make less than $25,000 have underlying conditions that make them more vulnerable to the novel coronavirus, and, as you can see in the chart below, the likelihood of having those conditions declines as incomes go up. And these numbers just look at respondents’ health — they don’t take into account what jobs these people do or whether those jobs are requiring workers to interact with the public and increase their risk of exposure.
Similarly, about 63 percent of Americans who did not graduate from high school are more vulnerable, while about 40 percent of college graduates have health issues that put them at increased risk.
The differences among income, education and racial groups reflect that those with more resources have better access to health care and more of the flexibility that makes healthy lifestyle changes possible (such as exercising or buying fresh fruits and vegetables).
In this pandemic, Williams said that those who were already disadvantaged will likely be hit hardest, as businesses close down and leave many low-income black and Hispanic workers out of a job, causing financial hardship even in the best of circumstances and making it even harder to see a doctor if they do get sick.
“I think we are looking at a perfect storm that can have pervasive adverse consequences. The people being most hurt by this epidemic are the very people who at the beginning of this epidemic were the most vulnerable,” he said.