New state health data provides more proof of the devastating and disproportionate impact of COVID-19 on New Jersey’s minority communities: The disease was the No. 1 cause of death for Blacks, Hispanics and Asians last year.
Preliminary New Jersey State Health Assessment Data for deaths in 2020 made available on Monday shows COVID-19 surpassed heart disease for Blacks, Hispanics and Asians. It was the third-largest cause of death among non-Hispanic whites, with heart disease remaining the dominant one, followed by cancer, for that racial group. State officials continue to update death data, which is derived from the causes listed on death certificates of New Jersey residents regardless of where they died, for a year or longer so some of the numbers could change.
It is particularly striking that the disease caused by the novel coronavirus jumped into the top spot given that the first COVID-19 death was not confirmed until almost a quarter of the way through 2020 — on March 10, 2020.
But doctors and health officials said the data is not surprising.
Most vulnerable suffer most
“What we know about pandemics and epidemics is that often the most vulnerable in our society experience the worst health outcomes in relation to the disease,” said Perry N. Halkitis, dean of the Rutgers University School of Public Health.
“COVID-19 has laid bare the vulnerabilities we knew Black, brown and Asian communities already have in our health care system,” agreed Dr. Kennedy Ganti, president-elect of the Medical Society of New Jersey who practices in Willingboro. “There are access to care challenges, social determinants of health challenges.”
Health officials have noted the disparate impact the virus was having on Black and brown communities, in particular, since early in the pandemic. The state’s COVID-19 information portal breaks out cases, hospitalizations and deaths by race. The state health commissioner typically relates some of this information during her briefings on the pandemic. But the fact that the disease was responsible for more deaths than other typical causes for Blacks, Hispanics and Asians puts that into sharper perspective.
“Since the beginning of the pandemic, the (Murphy) Administration has been focused on bringing resources to underserved communities because we recognize that the same long-standing inequities that have contributed to health disparities affecting racial and ethnic groups have also put them at increased risk for COVID-19,” said Dawn Thomas, a state Department of Health spokeswoman.
The state data shows that COVID-19 claimed 2,466 Black lives last year, with that number rising to 2,720 when related conditions, including unspecified coronavirus, flu and pneumonia, are added in. Heart diseases were responsible for 2,439 deaths. COVID-19 and related causes made up 20% of all deaths. COVID-19 and related causes killed more than 1,000 Asians and were responsible for more than a quarter of all deaths. For Hispanics, COVID-19 and related causes accounted for the largest percentage of all groups, with slightly more than a third of all those who passed dying from those illnesses. COVID-19 took 3,427, while COVID and related diseases were responsible for 3,654 deaths. More than twice the number who died from heart diseases, 1,454, succumbed to COVID-19.
By contrast, about 15% of deaths among whites last year were due to COVID-19 and related illnesses. Heart diseases were responsible for 22% of deaths, while 17% of deaths were from cancer.
“Look at the impressions we have of the number of individuals who were Hispanic and African American, who are more likely to be infected and then they’re more likely to have more severe disease and on top of everything else they are more likely to have bad outcomes from a whole variety of illnesses,” said Dr. Robert Johnson, dean of the Rutgers New Jersey Medical School and interim dean of Rutgers Robert Wood Johnson Medical School. One of the things that is important about the social determinants of health is all of these factors that are likely to adversely affect minority populations lead to increased death rates.”
Why more people of color die
Halkitis said there are a host of reasons why the illness is killing more people of color. Blacks and Latinx people tend to be of lower socioeconomic status due to structural inequities in society and they more often hold lower-paying frontline essential-worker jobs that put them at greater risk of getting COVID-19. They often live in more crowded conditions, which also puts them at greater risk. Blacks and Hispanics tend to have less access than whites to high-quality health care and they hold a greater mistrust of medical professionals based on culture and history, which means they may be less likely to follow public health messaging.
“All of those things taken together place them at risk for both acquiring and dying from COVID-19,” he said.
Additionally, the crackdown on undocumented immigrants during the Trump administration may also have made some Hispanics less likely to seek medical care once they became sick, Halkitis added.
“It’s a sad choice you have to make: Take care of your health or be arrested by ICE,” he said, referring to U.S. Immigration and Customs Enforcement. “That’s what people were confronted with in the last few years. They chose to take the risk with their health because they didn’t want to be deported away from their families.”
Dr. Shereef Elnahal, president and CEO of University Hospital in Newark, said the stark contrasts this data shows should be a wakeup call for policymakers to take greater actions to minimize the disparities.
“This data once again shows that COVID-19 has not only disproportionately impacted people of color, it has also exposed Black and Brown peoples’ asymmetric burden of chronic disease, higher representation in the essential workforce and lived experiences that predispose to greater spread of infectious diseases,” he said. “This should be a call to action for the equitable distribution of resources to communities of color related to the pandemic, but also for the more sustainable, long-delayed work in achieving health and economic equity in majority-minority communities thereafter.”
Solving systemic problems
Solving these problems, many of which are systemic, is a challenge. But in the short term, it means officials need to take greater steps to ensure that people of color are able willing and able to get the COVID-19 vaccines. The state dashboard currently shows great disparities in the racial and ethnic makeup of those being vaccinated: Of those for whom race or ethnicity was known, as of Monday morning, almost 60% were white, 7% Asian, 6% Hispanic and 4% Black.
Halkitis said part of the reason for the disparity is that health care workers were the first-priority category and they are mostly white. But other reasons why the percentage of minorities being vaccinated is so low is that many are leery of vaccines and those who want to be vaccinated are having difficulty figuring out how to do so. The system the state set up is predominantly internet-based and most of the sites giving vaccines are not linked to the state system.
“We need to make sure that vaccines are available in inner city communities and we need to make sure that people from these communities who are trusted by these communities endorse vaccination,” Johnson said. “We also need to make sure that people in these communities have health care.”