PRB

Adults ages 60 and older are at higher risk of severe illness and death from COVID-19, the disease caused by the novel coronavirus. However, older Black Americans are especially at risk. The latest provisional data from the Centers for Disease Control and Prevention show that while non-Hispanic Black adults make up 10% of the population ages 65 to 74, they account for 18% of COVID-19-related deaths in that age group.¹

The pandemic’s heavy toll on older Black Americans is linked to structural racism—larger systems of inequality embedded in major U.S. social institutions, Marc A. Garcia and colleagues argue.² These unequal structures limit Black Americans’ access to quality health care and increase their overall risk for chronic disease, premature aging, and COVID-19 infection.

Black Americans have less wealth than white Americans and are more likely to live in multigenerational and extended family households, making it hard to isolate and increasing their risk of contracting COVID-19, Garcia and colleagues point out. Black adults are also overrepresented in high-contact jobs, such as food service and retail, which cannot be done from home. These jobs tend to be lower paying and lack health benefits and paid sick leave.

The stress of living in a society with compounding, daily instances of discrimination, creates “weathering,” a process that increases stress hormones and inflammation, triggering premature aging, Garcia and colleagues explain. Weathering contributes to older Black adults’ higher rates of obesity, cardiovascular disease, diabetes, hypertension, and chronic lung disease relative to white adults. These underlying conditions put older Black adults at higher risk of complications from COVID-19, and when they become ill, they are less likely than older white adults to have access to quality medical care.

Garcia and colleagues argue that structural racism “drives weathering processes resulting in the greater chronic disease burden” among Black Americans “that elevates their risk of health complications and death from COVID-19.”

Linda M. Chatters, Henry Owen Taylor, and Robert Joseph Taylor point to several additional factors contributing to older Black adults’ higher risk for illness and death related to COVID-19:³

• Racial residential segregation. A growing body of research shows that because of discriminatory housing practices such as redlining, older Black adults are more likely to live in racially segregated neighborhoods characterized by higher rates of poverty, lack of health care services and amenities (such as grocery stores and parks), and poorly maintained housing and infrastructure. In addition to contributing to higher rates of stress, chronic disease, and functional impairments, these neighborhood conditions influence and heighten older Black adults’ coronavirus exposure and risk of severe infection.
• Racial disparities in long-term care facilities. The nursing homes and other group-living settings where older Black Americans live tend to be characterized by low levels of services, support, and oversight, jeopardizing residents’ health and putting them at high risk of COVID-19 exposure and severe infection and death.

Reducing racial disparities in COVID-related deaths will require addressing multiple aspects of structural racism, but Garcia and colleagues argue that important starting points include ensuring that testing and vaccines are available in African American communities, that low-wage workers have access to personal protective equipment and economic relief, and that health organizations’ practices do not have a disparate impact on low-income older Black adults.