Disparities in vulnerability to complications from COVID-19 arising from disparities in preexisting conditions in the United States.

The COVID-19 pandemic has magnified U.S. health disparities. Though disparities in COVID-19 hospitalization by race-ethnicity are large, disparities by income and education have not been studied. Using an index based on preexisting health conditions and age, we estimate disparities in vulnerability to hospitalization from COVID-19 by income, education, and race-ethnicity for U.S. adults. The index uses estimates of health condition and age effects on hospitalization for respiratory distress prior to the pandemic validated on COVID-19 hospitalizations. We find vulnerability arising from preexisting conditions is nearly three times higher for bottom versus top income quartile adults and 60 % higher for those with a high-school degree relative to a college degree. Though non-Hispanic Blacks are more vulnerable than non-Hispanic Whites at comparable ages, among all adults the groups are equally vulnerable because non-Hispanic Blacks are younger. Hispanics are the least vulnerable. Results suggest that income and education disparities in hospitalization are likely large and should be examined directly to further understand the unequal impact of the pandemic.

Disparities in Vulnerability to Severe Complications from COVID-19 in the United States.

This paper provides the first nationally representative estimates of vulnerability to severe complications from COVID-19 overall and across race-ethnicity and socioeconomic status. We use the Panel Study of Income Dynamics (PSID) to examine the prevalence of specific health conditions associated with complications from COVID-19 and to calculate, for each individual, an index of the risk of severe complications from respiratory infections developed by DeCaprio et al. (2020). We show large disparities across race-ethnicity and socioeconomic status in the prevalence of conditions which are associated with the risk of severe complications from COVID-19. Moreover, we show that these disparities emerge early in life, prior to age 65, leading to higher vulnerability to such complications. While vulnerability is highest among older adults regardless of their race-ethnicity or socioeconomic status, our results suggest particular attention should also be given to the risk of adverse outcomes in midlife for non-Hispanic Blacks, adults with a high school degree or less, and low-income Americans.