Racial Data and COVID-19: Why it Matters

When Utibe Essien started tracking the spread of COVID-19 into the U.S., he thought about his family in New Rochelle, New York.

The state quickly became an epicenter for the novel coronavirus due to its high population, and New Rochelle is just 25 miles away from New York City—one of the hardest-hit cities in the country.

“It was striking to see the maps of the cities I was raised in and went to college and church in be significantly hit by this virus,” said Essien, assistant professor of medicine at the University of Pittsburgh School of Medicine.

For the past 12 years, Essien has been researching racial disparities in disease testing and care.

Essien arrived at Pitt in 2018 after graduating with a Master of Public Health degree in Clinical Effectiveness from Harvard University’s T.H. Chan School of Public Health. Prior to that, he received his Doctor of Medicine from the Albert Einstein College of Medicine and studied psychology at New York University. He also completed his primary care residency and General Internal Medicine fellowship at the Massachusetts General Hospital.

While much of his research has focused on improving access to cardiovascular therapies, his most recently published article, which is a preprint in collaboration with the Yale School of Medicine, examined racial disparities in deaths and reporting related to COVID-19.

The team found that only 28 states were tracking race and ethnicity in their reporting. That number has improved since the paper’s study period began in April, Essien said, but there remain broad differences in reporting.

“Some states had as much as 40% of race and ethnicity missing; some had 20 or 30%. We also found that, adjusting for age, Black Americans were dying at three and a half times the rate as White Americans from COVID-19. Latinx Americans were dying at about two times the rate of White groups,” he said.

“While there have been people studying this virus at the cellular level and developing vaccines, there didn’t seem to be enough conversation around these structural or social factors that were making it so people who look like me are dying at three and a half times the rate of our White counterparts,” said Essien.

Cary Gross, professor of medicine at Yale and one of the study’s co-authors, said the study’s initial big-picture goal was to aggregate data from all states in terms of equity in COVID-19 mortality.

“To get to that point, we had to first look for missing data across states and how that relates to our ability to track COVID-19 outcomes according to race and ethnicity,” Gross said.

The researchers said that it’s important for race to be accounted for in reporting cases for COVID-19, along with any other diseases, because such diseases affect people differently. Factors like economic disparity and access to testing also come into play for reporting.

“Of the 27 million Americans who are uninsured today, a large proportion are Hispanic or Black,” Essien said. “This virus was once called the great equalizer, but now we’re finding it’s really the great un-equalizer or the great revealer in that it’s really revealed the structural inequities in our system.”

Jane Liebschutz, chief of Pitt’s Division of General Internal Medicine and professor of medicine, has worked with Essien on opioid prescribing equity issues and praised his high “emotional IQ” in studying systemic issues.

“Our country is imbued with racism; it’s important to understand so we can do something about it,” said Liebschutz, who is also one of Essien’s mentors. “He brings a perspective that really cuts through a lot of complex ideas and interactions. He’s able to bring a positive perspective to understanding disparities and finding solutions for them.”

Gross said the Pitt-Yale team plans to update its data and hopes to answer why some states have more disparities than others when it comes to the pandemic. He also called Essien “a terrific collaborator.”

“He brings rigorous methods to the research questions,” Gross said. “He is great at identifying the important questions and making sure we answer them in the right way.”

Essien hopes systems will be put in place to solve this problem. He says in the short term, researchers need continuous access to data, since some race-related data in relation to COVID-19 is still missing. This includes more contact tracing. For that, engagement with community resources needs to be done.

“Our track record over the last few decades has shown us that there’s a lot of mistrust in the health care system by communities of color, and unfortunately, rightfully so,” Essien said.

For the long term, researchers and health care professionals need to think about community social services to help people who may not be financially secure. Along with that, access to insurance should be expanded.

As for his family, Essien said they are all managing well through the pandemic.

“At the start of the pandemic I was trying to convince them to come to Pittsburgh since we seemed to have been spared from the worst of the virus,” he said.