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These Underlying Conditions Put Blacks, Hispanics at Higher Risk of Severe COVID-19

Diabetes, high blood pressure, obesity, heart failure prevalent in hospitalized patients

Nurse comforting patient, both wearing face masks

Hispanolistic/Getty Images

En español | Black adults hospitalized with COVID-19 are more likely to suffer from obesity, hypertension, diabetes and heart failure than their white counterparts, according to a study that found that these preexisting conditions were evident in nearly two-thirds of the 906,849 American adults hospitalized as of Nov. 18, 2020.

But for those preexisting conditions, which are often associated with poor diet, as many as 575,419 adults in the United States, including many 50 and older, may have avoided hospitalization, according to the study, which was led by Tufts University researchers and published in the Journal of the American Heart Association. Doctors refer to obesity, hypertension (high blood pressure), diabetes and heart failure as cardiometabolic conditions.


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"Our findings lend support to the need for prioritizing vaccine distribution, good nutrition and other preventive measures to people with cardiometabolic conditions, particularly among groups most affected by health disparities,” lead author Dariush Mozaffarian, a cardiologist and dean of Tufts’ Friedman School of Nutrition Science and Policy, said in a statement.

In breaking down the numbers, the researchers noted that disparities were evident by age, race and ethnicity.

Together, the four preexisting conditions factored into 44.2 percent of COVID-19 hospitalizations among those ages 18 to 49, 64.5 percent among those 50 to 64 years old and 73.9 percent among those 65 and older. The proportion of hospitalizations attributable to the four conditions combined was highest in Black adults of all ages, followed by Hispanics, according to the study. Among young adults ages 18 to 49, the four conditions jointly were estimated to cause about 39 percent of COVID-19 hospitalizations among white subjects, compared with 50 percent among Black adults.

Separately, the preexisting conditions have a wide-ranging role across age, race and ethnicity among adults hospitalized with COVID-19.

  • Diabetes ranged from 6.1 percent among white patients (ages 18 to 49) to 33.7 percent among Hispanics 65 and older.

  • Hypertension ranged from 7.4 percent among Hispanics (18 to 49) to 38.1 percent among Blacks 65-plus.

  •  Heart failure ranged from 0.7 percent among white patients (18 to 49) to 28.2 percent among Black patients 65-plus.

  •  Obesity (BMI 30 to 40) ranged from 14.6 percent among Asians 65-plus to 24.1 percent among Hispanics (ages 50 to 64).

  • Severe obesity (BMI >40) ranged from 6.7 percent among Asians (ages 18 to 49) to 16.9 percent among Black patients (18 to 49).

The estimates were extrapolated from data collected on more than 5,000 patients hospitalized from March 1 to April 8, 2020, in New York City with laboratory-confirmed COVID-19.


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"The strong links between these conditions and poor outcomes in COVID-19 provide a compelling signal to clinicians and policymakers on additional approaches to improve population resilience for COVID-19 as well as future pandemics,” the researchers wrote.

Public health messages on strategies to avoid infection (such as social distancing, wearing face masks and handwashing) should stress the critical risk that the coronavirus poses to adults with underlying cardiometabolic conditions. The results also support the need to prioritize vaccinations of the elderly, Blacks and Hispanics at higher risk of severe illness.

"Prevention campaigns and activities should focus on and target these individuals to minimize the burden of severe infection and hospital caseload,” they wrote.

The investigators also suggest the need for additional research to determine whether improving cardiometabolic health will reduce hospitalizations and deaths caused by COVID-19.

"We know that changes in diet quality alone, even without weight loss, rapidly improve metabolic health within just six to eight weeks. It's crucial to test such lifestyle approaches for reducing severe COVID-19 infections,” Mozaffarian said.

Underlying Conditions in Hospitalized COVID-19 Patients

Here's what the researchers determined were the proportion of COVID-19 hospitalizations of adults ages 50 to 64 that were attributable to the four underlying conditions.

And among adults 65 and older

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