The current novel coronavirus (COVID-19) pandemic has highlighted health disparities in the United States. Compared with white patients and/or those with a higher income, patients who are black, American Indian, or live in low-income households are more susceptible to COVID-19, according to research published in the American Journal of Preventive Medicine.

“These inequities in risk are compounded by structural disparities in access to medical insurance, wealth, and income volatility,” reported the investigators. “Identifying those at a heightened risk of severe illness is essential for modeling disease, advancing health equity, and limiting morbidity and mortality.”  Specifically, for COVID-19, it will be necessary to design return-to-work criteria and allocate economic assistance.

To identify patients at heightened risk, the researchers used data from the 2018 Behavioral Risk Factor Surveillance System which captured survey results from >400,000 adults. Participants were included that had at least 1 of the Centers of Disease Control and Prevention criteria for risk of severe illness from COVID-19 by age group, race/ethnicity, and household income (<$25,000).

A total of 387,304 participants were identified for the overall and race/ethnicity analyses and 336,861 for the income analysis. The researchers found that approximately 97 million Americans (43% of adults) were at higher risk of illness from COVID-19. Among those aged <65 years, 28% were at higher risk, including 18% of those aged 18 to 24 years.

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These health disparities in risk were found across age groups, noted the researchers. Of those <65 years of age, 33% of black and 42% of American Indian adults were at higher risk compared with 27% of white adults. A total of 11% of black and 18% of American Indian people had multiple risk factors compared with 8% of white people. Among those aged ≥65 years, 69% of American Indian and 61% of black people had additional risk factors beyond age compared with 54% of white people.

When looking at income, the researchers found that at least 25 million low-income Americans were at higher risk for COVID-19; among those aged <65 years, 40% of low-income people were at higher risk compared with 24% of those with higher income. Income disparities was associated with multiple risk factors among those aged <65 years (16% low-income vs 6% higher-income) and >65 years (63% low-income vs 52% higher-income.

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“It is vital that these race/ethnicity and income disparities in risk be consider in physical distancing policies and other protective measures, particularly for those who work in essential industries,” concluded the authors.


Raifman M, Raifman J. Disparities in the population at risk of severe illness from COVID-19 by race/ethnicity and income. Am J Prev Med. In press.