Age-adjusted rates of COVID-19-associated hospitalizations continue to be more than three times higher for several non-white racial and ethnic populations than for white populations, according to data for March 1 through December 12 reported by the Centers for Disease Control and Prevention (CDC).
Those figures underscore the need for studies of potential COVID-19 treatments to prioritize inclusion of minority populations. Advocates for clinical trial diversity point to the study populations of recent vaccine trials as evidence that although minority representation is slowly increasing, the numbers are still far below where they should be, particularly in light of the elevated risks in minority populations.
The CDC analysis is based on data from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), which conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP). Among the 96,444 laboratory-confirmed COVID-19-associated hospitalizations analyzed by the CDC, 94,432 (97.9%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 2,012 (2.1%) cases.
When examining overall age-adjusted rates by race and ethnicity, the rate of hospitalizations for Hispanic or Latino persons, non-Hispanic American Indian or Alaska Native persons, and non-Hispanic Black persons were approximately 3.7, 3.5, and 3.2 times the rate among non-Hispanic White persons, respectively.
When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, crude hospitalization rates were 5.0 times higher among Hispanic or Latino persons aged 0–17 years; 6.5 times higher among Non-Hispanic American Indian or Alaska Native persons aged 18–49 years; 4.5 times higher among non-Hispanic American Indian or Alaska Native persons and Hispanic or Latino persons aged 50–64 years; and 2.5 times higher among non-Hispanic Black persons aged 65 years or older.
A key reason for increased COVID-19 risk in minorities is that Black and Latino people are more likely than their white counterparts to have jobs that require close contact with others, such as in retail or manufacturing. Also, if they contract the virus, they are more likely to have serious cases of the disease, because of a higher rate of some chronic diseases and less access to the health care system, said Carla Williams, an associate professor of medicine and public health at Howard University in Washington, D.C.
Participants in U.S. clinical trials for the two COVID-19 vaccines granted emergency use authorization by the U.S. Food and Drug Administration are more racially and ethnically diverse than for most trials, said Namandjé Bumpus, director of the pharmacology and molecular sciences department at Johns Hopkins University in Baltimore. But Blacks are underrepresented in both, compared to their share of the U.S. population, and Latinos and Asians are underrepresented in one, according to data from the companies developing the vaccines.
In clinical trials for the Pfizer and BioNTech vaccines, 10% of U.S. participants were Black. Latino patients made up 20% of the Moderna trial population and 26% of the Pfizer-BioNTech trial population.
Pfizer spokeswoman Sharon Castillo said the company tried to maximize the number of Black and Latino participants by locating research sites in minority communities, working with Black and Latino organizations and targeting social media and other advertising — including in Spanish — at Black and Latino communities.
"We are not going to undo underrepresentation in a blink of an eye," Castillo told Newsday. "This is going to be a process. This has been a great first step."
Moderna officials did not respond to interview requests.
A 2011 FDA report put Black representation in studies of drugs submitted for FDA approval at 5% and Latino participation at 1%. An FDA report covering 2015-19 put the numbers at 16% Black and 15% Latino. But the FDA warned against making year-by-year comparisons, and a 2019 study of cancer-drug trials found much lower representation. "It's very difficult to get accurate data" because many trials do not report race and ethnicity, so statistics are incomplete, Bumpus said.
She said drug companies face distrust from many people of color.
A survey released in October by the Kaiser Family Foundation and The Undefeated found that Black people were much more likely than whites to distrust the health care system and say it's biased, and were less likely to say they’ll get a coronavirus vaccine.
But, Bumpus said, "There also are data out there to show that folks just aren’t being asked, that African Americans and Latinos aren’t given the same access to participate and enroll in clinical trials."
A federal government study of 600 Black men at the Tuskegee Institute in Alabama from 1932 to 1972 looms large in distrust of the system. The government aimed to learn about the progression of untreated syphilis, which is potentially deadly, and told the men they were getting treatments, even though they were not.
But it’s not just the past.
Multiple studies have shown Black patients are less likely to receive pain medication than whites, or they receive lower doses. A 2016 study found that half of medical students believed falsehoods about Black people’s biology and many minimized Black patients’ pain levels.
Jacqueline Winston, president of the Suffolk County Black Nurses Association, said she has noticed that some white doctors are less attentive and interactive with Black patients, which can lead to medical problems not being noticed and treatment delayed.