How Can We Address The Sobering (but Unsurprising) Minority Disparities in COVID-19?
From early on in the COVID-19 pandemic, anecdotal evidence showed higher rates of COVID-19, and higher rates of severe COVID-19, among minority groups. But there were still questions. Is this just in big cities? Are there racial disparities in outcomes in every age group? As more data began to come out, these variances became even more apparent. In early July, The New York Times published the most stark look at the data yet.
“Latino and African-American residents of the United States have been three times as likely to become infected as their white neighbors, according to the new data, which provides detailed characteristics of 640,000 infections detected in nearly 1,000 U.S. counties. And Black and Latino people have been nearly twice as likely to die from the virus as white people, the data shows,” the article states.
What’s even more sobering about this data is it is only reflective of the first wave of cases through the end of May. Since then, more studies like this one in JAMA Internal Medicine have confirmed a disproportionate rate of COVID-19 hospitalizations in racial and ethnic minorities.
COVID-19 is shining a spotlight on an already serious problem the public health community has been fighting for years: health inequity in minority communities.
Why is COVID-19 Impacting Minority Communities More?
The New York Times article hits on some key reasons the coronavirus is taking a heavier toll on minorities: more likely to be exposed due to essential, front-line jobs that prevent them from working from home, more likely to rely on public transportation or live in multigenerational, smaller homes.
Many experts have also pointed out that blacks and hispanics are more likely to have underlying health conditions that can lead to a more severe case of COVID-19, like obesity, heart disease, and Type 2 Diabetes. And this is true, too - largely due to the same health inequities that have led to worse COVID-19 outcomes.
Overall, large life expectancy gaps occur most frequently in cities that have higher levels of racial and ethnic segregation. Looking at differences by ethnicity, it’s clear that chronic conditions disproportionately impact minorities, too. The U.S. Centers for Disease Control and Prevention (CDC) reports that nearly 44% of African American men and 48% of women have some form of cardiovascular disease. And, they are 30% more likely than white patients to die prematurely from heart disease and two times as likely to die prematurely from stroke. Obesity, which has many associated chronic diseases, also impacts minorities more so than others. Hispanic children ages 2 to 19 had the highest prevalence of obesity in the U.S. (21.9%), while Mexican Americans, specifically, suffer more from diabetes than other Hispanics.
But how did we get here in the first place, and how can we proactively manage chronic conditions in minority populations?
The disparities presented here go beyond race and ethnicity and suggest the impact of social determinants of health, particularly socio-economic status.
How Can We Address Health Disparities Today?
Beyond preventative measures specifically for COVID-19 like hand washing, social distancing, and mask wearing and more widespread testing and contact tracing, we need a better way to manage chronic conditions - with or without our public health emergency.
Healthcare needs a makeover, particularly in how patient education and patient care are delivered. Healthcare experts have for years had a goal to “meet patients where they are”, but it’s usually discussed in terms of health literacy, or where they are in their journey to better health. But to truly meet patients where they are--physically and literally--we need to think outside the box, looking to solutions like Remote Patient Monitoring and digital, easy-to-access patient education.
Virtualized Patient Education and Care
Traditionally, patients receive education a number of ways. They may get a brochure or pamphlet at the doctor’s office. Their doctor may recommend they enroll in an in-person, disease-specific program at their hospital. Maybe their church or community center offers education as well. However, education rates for some of the costliest chronic conditions are still low. For example, The American Diabetes Association (ADA) recommends that individuals with diabetes receive Diabetes Self-Management Education and Support (DSME-S) at diagnosis and as needed thereafter. DSME-S programs are meant to address a variety of factors that impact the patient’s health and ability to manage their diabetes, including: the patient’s health beliefs, cultural needs, health literacy, current knowledge, physical limitations, family support, financial status, medical history and other factors. Despite the benefits of DSME-S, only 6.8% of individuals with newly diagnosed type 2 diabetes with private health insurance participated in DSME/S within 12 months of diagnosis. Furthermore, only 4% of Medicare participants received DSME/S.
When you consider that many minorities struggle with transportation or finding child care, and many work hourly jobs with no paid time off to see a doctor much less attend a program about their health condition, it’s no wonder in-person patient education isn’t as effective as it should be.
The same factors apply to in-clinic doctor’s appointments. Why are we asking a single mother with type 2 diabetes to leave work, hop on a train or fight traffic across town and pay for parking outside their doctor’s office just so we can check their blood sugar?
What can we accomplish by making both chronic disease management and education more accessible? What role does technology play?
Rimidi Makes Remote Patient Monitoring and Digital Patient Education Effective and Efficient for Patients and Providers
Rimidi’s Remote Patient Monitoring platform combines patient-generated health data from connected devices like blood pressure cuffs, scales, and blood-glucose meters with clinical data from the EMR to enable a continuous model of chronic disease management, offering clinicians a more holistic and proactive view of their patients’ health, and improving patient adherence and engagement.
In addition to Remote Patient Monitoring, Rimidi is committed to leveraging grassroots efforts and technological innovations to provide better access to education and management tools for underserved communities. One example is the Tri-Cities Diabetes Equity Project, a grassroots effort focused on delivering digital Diabetes Self-Management Education and Support (DSME-S) in Atlanta’s Tri-Cities community of College Park, East Point, and Hapeville -- an area that has a disproportionately high rate of diabetes compared to neighboring communities.
