For much of a generation, medical data—when categorized by race—has shown that African-Americans experience the worst health outcomes of any community in the nation. This has been particularly true during the pandemic.

Now, a paper in the Journal of General Medicine (published by Harvard University) at last quantifies the inequities in the COVID-19 mortality rate in looking at both race and sex. Black women are dying at significantly higher rates than White men. Disparities in mortality rates among women of all races are greater than those between White men and White women.

Mortality rate four times higher

Key findings of the study revealed that Black women have COVID-19 mortality rates that are nearly four times higher than that of White men. The rate is three times higher than that of men of Asian-Pacific Islander (API) as well as higher than White and API women.

Black men have far higher mortality rates than any other sex and racial group. It’s six times higher than the rate among White men.

The disparity in mortality rates between Black women and White women is more than three times the disparity between White men and White women. Finally, the disparity between Black men and Black women is larger than the disparity between White men and White women.

A ‘complicated narrative’ of racism and genetics

“This analysis complicates the simple narrative that men are dying at greater rates of COVID-19 than women,” said Tamera Rushovich, a Harvard Ph.D. candidate and lead author of the report. Rushovich explained that the unique research project further verified that racism and social inequities—not genetics—are responsible for the widening disparities in COVID-19 mortality.

“Many researchers have focused on differences in biology to explain the sex disparity COVID-19 mortality,” Rushovich noted. “This paper’s findings challenge the sole focus on biology as an explanation for sex differences in [mortality]. We argue that societal factors related to gender in combination with racism and socioeconomic stratification are important explanatory factors.”

Rushovich’s team conducted an observational study. They used data from Georgia and Michigan—two states that early began reporting COVID-19 deaths by age, sex and race. The researchers really weren’t sure what they would find, but as the figures came in they saw that the disparity was heavily influenced—if not primarily driven—by social factors.

Chronic conditions among Black women

The high rate of chronic conditions among Black women (i.e. high blood pressure, heart disease, high cholesterol, diabetes and obesity) have made this group far more susceptible to a fatal bout with COVID-19.

“It has to do with the underlying conditions that Black women have and the fact that many of them are on the front lines as essential workers,” said Dr. James Hildreth, an infectious disease expert and president of Meharry Medical College in Nashville, Tenn. “I said from the beginning that our most vulnerable populations should be the first to get tested. Now that vaccines have become available, these populations should be the first to get them. The findings in the Harvard study tend to bear that out.”

There are “social determinants” of health. Those factors include a person’s access to good healthcare, a quality education, the neighborhood you reside in, the job you have, food security, and even how much discrimination you may encounter, as this latter issue may factor into undue and harmful stress levels.

“In some places, your ZIP code is a better predictor of your health than almost anything else,” Hildreth said.

The role of structural racism

The research, of course, revealed that structural racism has played a significant role in the exorbitant mortality rate between Black women and White men. Structural racism, in this case, is closely aligned with pre-existing conditions. The study further revealed that the outcome of these aspects of American society have been further magnified by the pandemic.

“Societal factors such as living conditions, economics, systemic racism have played a significant role in as to why Black women are affected by health disparities at a much higher rate,” said Dr. Helena Johnson with Black Women Rally for Action (BWRA), a local coalition that advocates for the health and well-being of African-American women. “Black women don’t receive the same amenities as others. There’s lower household income. Unsafe neighborhoods equate crime that leads to undue stress. The food and pharmacy deserts contribute to poor health outcomes.”

Johnson, also president of the National Council of Negro Women—Southern California, explained that BWRA is dedicated to reporting the stories of not just Black women, but the local African-American community in general in gathering and disseminating the “valid facts” to this community. This is specific to releasing the latest COVID-19 racial data including age, cases, deaths and vaccination rates by gender.

“This has never been so important as it is during the pandemic,” Johnson added.

Generational discrimination

As the pandemic ebbs, the pre-existing conditions among Black women will remain. Early on, researchers saw the differences in gender outcomes as biological, therefore there was consideration given to injecting the female hormone estrogen to older men, as an experimental treatment for COVID-19. They realized, however, that if that gender-based premise were true, a similar sex disparity would be apparent across different locations. It wasn’t. In the end, the prime determinant was the aggregate of generational discrimination suffered by the Black community.

“The findings of vastly different male-female mortality rates across racial groups in the U.S. indicates that the sex-disparity in mortality among COVID patients is largely rooted in social factors,” Rushovich explained.

The roles played by Black women in the workforce is likely one factor in their higher death rate. Essential workers—a field of which Black women represent a high percentage—are at higher risk of being infected by the virus.

Black women on the ‘front line’

Front-line jobs—including nursing home assistants and home health aides—are also disproportionately performed by females of color. Department of Labor Statistics reveals that African-Americans represent about 30 percent of bus drivers, and nearly 20 percent of all food service workers, custodians, cashiers, and stock clerks. During a highly contagious pandemic like COVID-19, Black workers—and consequently their families—are overexposed.

Physical wellbeing can play a considerable role in good health outcomes. The better condition you’re in, the least likely an infection will wreak havoc on the body. African-Americans, relative to Whites, are least likely to reside in neighborhoods that provide healthy food options, green spaces, recreational facilities, proper lighting, and overall safety.

“Health disparities have always existed for the African-American community…[coronavirus is] shining a bright light on how unacceptable that is because, yet again, when you have a situation like the coronavirus, they are suffering disproportionately,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “We will get over the coronavirus, but there will still be health disparities which we really do need to address in the African-American community.”

‘The price we pay for inequality’

Black people are more likely to live in densely populated areas, further heightening their potential contact with [possibly] infected people. Environmental pollution—as well as climate change—also creates challenges in the Black community. Predominantly Black neighborhoods are more likely to be exposed to pollutants and toxins. A look at the poor quality of drinking water in areas like Watts and in Flint, Mich. may verify the environmental risks to African-American health.

“Health maladies in the Black community tend to manifest not because Black persons don’t take care of themselves, but because healthcare resources are inadequate in their neighborhoods,” Johnson said. “The same can be said of environmental pollution. Millions of African-Americans reside in areas contaminated with industrial waste.”

The imbalance also holds true when it comes to the race to immunize Americans against the virus. Separate research has found that not only are Black and Latino Americans more likely to die from COVID-19, they’re also less likely to be vaccinated against it.

Collectively, the specter of structural racism and micro-level outcomes can equate to a recipe for disaster where the consequences are African-American’s increased exposure, diagnosis, and death from coronavirus. When a crisis like the COVID-19 pandemic occurs, inequalities are exacerbated rather than diminished. After pouring over the data from the Harvard study, Rushovich may have explained it best in noting:

“It’s the price we pay for inequality.”