As the coronavirus pandemic unfolds in the US, certain trends are beginning to emerge, including data on segments of the population that are experiencing relatively high rates of serious complications that frequently require hospitalization and, often, treatment in intensive care units. The healthcare community understood early on that older individuals and those with underlying chronic conditions—including high blood pressure, heart disease and diabetes—were particularly vulnerable.
Against this backdrop, in early April the lay press began reporting on early analyses demonstrating that African Americans with coronavirus were particularly prone to hospitalization. Most notably, the CDC published data on April 8 showing that among all COVID-19-associated hospitalizations, one-third occurred in African Americans, a disproportionately high number given that blacks make up roughly 13% of the US population.
While the general public is rightly alarmed by this development, public health experts saw this coming. Racial health disparities have existed for decades, and have led to higher rates of chronic disease and death. It is paradoxical that clinical trials designed to improve specific chronic conditions often exclude African Americans because these individuals have comorbidities that may interfere with generating valid study results.
Finding ways to address this paradox starts with an awareness of the reasons for health disparities in minority communities, and a willingness to implement solutions based on inclusion and community engagement. Consider listening to these podcasts from healthcare clinicians, clinical trials professionals, and community advocates that address the issue from multiple angles:
- Jonca Bull, MD, former FDA Assistant Commissioner for Minority Affairs, refers to coronavirus in patients from low-income and minority communities as the “thread that unravels” the health disparity issues that have long been seen in minority patients. These include lack of access to care, living in unhealthy environments, food deserts, and other factors. Dr. Bull, who has specific expertise in advancing clinical trials diversity and bioethical considerations for such trials, explains why diversifying studies is crucial, and how upfront planning and communication strategies can allow more inclusive participation. Listen to Podcast >
- Edith Mitchell, MD, Oncology and Director of the Center to Eliminate Cancer Disparities, and Associate Director of Diversity Affairs at the Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital in Philadelphia, talks about the unevenness of data emerging about COVID-19 and its impact on minorities. This is due largely to the absence of testing and testing sites, as well as limited availability of demographic information on individuals who have been tested. She expands on Dr. Bull’s observations as to why health disparities exist in the first place, including the absence of paid sick leave, inadequate health insurance, income disparities, lower rates of health insurance coverage, and lack of access to healthcare facilities. Added to this are new disparities with COVID-19, including the inability for many minorities to work from home and lack of access to personal protective equipment while working. Dr. Mitchell also addresses the path forward, including using the small but important gains seen with the Affordable Care Act (ACA) as a potential blueprint. Data shows that the ACA is improving access to care for minorities with cancer, helping them live longer, and providing a better quality of life. Listen to Podcast >
- Charlotte Owens, MD, MD, FACOG, Medical Director at AbbVie Pharmaceuticals, explains how she fosters inclusion of individuals in underserved minority communities in clinical trials she directs. Dr. Owens specifically addresses how to overcome common obstacles that can prevent such inclusion. Listen to Podcast >
- Patient advocate and community leader Thomas Farrington, addresses how to reduce prostate cancer incidence in the African American community. Farrington, a prostate cancer survivor and President and Founder of the Prostate Health Education Network, has created networks of families in minority communities designed to raise prostate health awareness. Listen to Podcast >
In addition, consider reading these thought-provoking blog posts from patient advocates Kimberly Richardson and Wenora Johnson, who fight health disparities at the community level by fostering connections with clinical researchers.
- Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019: CDC
- COVID-19 underscores wealth and health disparities in the African American community: National Medical Association
- Communities in Action: Pathways to Health Equity: National Academies of Sciences
- Increasing diversity in clinical trials: Overcoming critical barriers.
- NHIT-Community Transformation Forum: National Health Collaborative for the Underserved
About the Authors
Steve Smith | President, Patient Advocacy, WCG
Lori Abrams | Senior Director, Advocacy, WCG
Lori has a long history of improving clinical drug development by including patients, caregivers and advocacy groups into every aspect of the development continuum. In her last corporate role, Lori was the Director of Diversity & Patient Engagement in R&D at Bristol-Myers Squibb (BMS). She continues to be a frequent speaker, writer and Advisory Board member on patient engagement and diversity in clinical trials.