Black, Latino, and Native American communities in the United States have been disproportionately affected by the COVID-19 pandemic compared with White communities. Since the pandemic began in the United States in March 2020, people in these communities have often been more likely to get sick and more likely to die from the disease compared with people in White communities.
But, in order to understand why any of these disparities exist (and how to eliminate them), it's important to understand why each of them exist within the communities they do. That's the point a group of Latino public health researchers make in an article published in the journal Cancer, which focuses on disparities and their drivers in U.S. Latino communities (2021; https://doi.org/10.1002/cncr.33401).
For oncologists, it's important to pay attention to these disparities in COVID-19 outcomes because often they're the same ones driving disparities in cancer outcomes in Latino communities; and the results of COVID-19 inequities threaten to widen the cancer gaps, the researchers point out.
"When local governments classified essential workers as part of the COVID-19 public health emergency response, a disproportionately high rate of Latinos employed in essential jobs emerged, and this resulted in occupation being a strong driver of COVID-19 infection in these communities," the coauthors noted in the article.
Additionally, Latinos have lower access to health care, which includes cancer screening and treatment due in part to lack of insurance, inadequate insurance coverage, and among immigrants, fear of deportation, historical racism, and linguistic and social isolation when seeking medical care. These thoughts were shared with Oncology Times by the study's lead author Elena Martinez, PhD, Professor in the Herbert Wertheim School of Public Health and Human Longevity Science and Associate Director of Population Sciences, Disparities and Community Engagement at UC San Diego Moores Cancer Center.
"We wrote the commentary because we felt that relatively few published reports focused on the unique inequities, characteristics, and contributors of COVID-19 in Hispanic/Latino populations," said Martinez, who is also the Sam M. Walton Endowed Chair for Cancer Research at UC San Diego. "As Latino academics, we are fully aware of the disproportionate impact the pandemic has had in marginalized and underserved Latino groups."
Some of the disparities the researchers highlighted in the paper include the following:
* According to data from the CDC, age-adjusted hospitalization rates were highest among Latinos and lowest among non-Hispanic Whites.
* In California, Latinos are the largest racial/ethnic group, comprising 39 percent of the population, but accounted for 60.6 percent of all COVID-19 cases and 48.5 percent of deaths, according to data from the California Department of Public Health from November 2020.
* Latino patients with cancer are more likely to become infected with COVID-19 than White patients with cancer, according to data from the ASCO CancerLinQ database.
"For this population, the highest burden of infection and death has been in younger individuals. This higher burden in younger Latinos is concerning because these individuals are the target age group for the initiation of cancer screening and early detection," Martinez added. The added burden of COVID-19 for this group places another burden to cancer screening and diagnosis for this population, she said.
Addressing the Issue
This problem is a systemic one and the solutions lie outside of what the oncology community alone can do. But there are steps that oncologists and community-based health organizations can take now.
"On the community side, we need to continue grassroots strategies, advocacy, and community empowerment," Martinez said. "The under-representation of Latino scientists and physicians is another barrier that needs to be addressed through workforce diversity and education. We need the voices of Latino leaders."
Martinez's team over the last year has been involved in research to increase COVID-19 testing and vaccination in Latino communities, working with grassroots Latino community-based organizations. "This work also extends to identifying and implementing solutions for cancer screening that are COVID-adaptable," she said.
"Our approach is through meaningful, respectful, and bidirectional community engagement where all community voices are heard and where approaches are culturally and linguistically tailored to Latino communities in urban and rural areas from California. On a broader level, we are leaders within our comprehensive cancer centers conducting community outreach and engagement efforts," she added.
"It is also important to recognize that we have evidence-based approaches (such as navigators and community health workers) that can provide language and culturally appropriate services and education; we just need to fund them."
In September 2020, the American Association for Cancer Research issued an in-depth report covering the latest research on why disparities in cancer incidence, diagnosis, treatment, and survival persist in the United States (http://cancerprogressreport.aacr.org/disparities/). A key point in that report is that effects of COVID-19 disparities will likely exacerbate other health disparities, like those in cancer. The report called for these priorities to help address the disparities on a larger scale:
* Health insurance opportunities for those financially strained should be expanded and made more available.
* Public hospitals should be supported.
* Public health and educational messages should be tailored to minority groups.
* Clinical trials related to COVID-19 must have adequate representation of racial and ethnic minorities.
Finding Larger Solutions
Outside of what oncologists and community-based efforts alone can do, a national focus on addressing the root causes of these inequities is essential, too. Barriers to access medical care and health insurance coverage, crowded housing, and police brutality are all barriers to more equitable health care-and COVID-19 and cancer outcomes, Martinez explained. "We must also continue to expand Medicaid coverage and provide adequate financing for Federally Qualified Health Centers and other safety net facilities that provide medical care, cancer screening, and appropriate and timely cancer survivor follow-up and support to individuals in Latino communities."
The current administration has taken steps to move the federal response in the right direction, but there's much more work to go, Martinez added. Deficits in funding, meaningful and bi-directional community engagement, support for grassroots efforts, patient navigators and community health workers who focus on health equity, and Latino health care providers, however, are all still barriers to progress, she noted.
Sarah DiGiulio is a contributing writer.