Asian-Americans and Pacific Islanders in COVID-19: Emerging Disparities Amid Discrimination
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Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA; 2Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA; 3Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
Coronavirus disease 2019 (COVID-19) is a global pandemic. In the USA, the burden of mortality and morbidity has fallen on minority populations. The understanding of the impact of this pandemic has been limited in AsianAmericans and Pacific Islanders (AAPIs), though disaggregated data suggest disproportionately high mortality rates. AAPIs are at high risk for COVID-19 transmission, in part due to their over-representation in the essential workforce, but also due to cultural factors, such as intergenerational residency, and other social determinants of health, including poverty and lack of health insurance. Some AAPI subgroups also report a high comorbidity burden, which may increase their susceptibility to more severe COVID-19 infection. Furthermore, AAPIs have encountered rising xenophobia and racism across the country, and we fear such discrimination only serves to exacerbate these rapidly emerging disparities in this community. We recommend interventions including disaggregation of mortality and morbidity data, investment in community-based healthcare, advocacy against discrimination and the use of non-inflammatory language, and a continued emphasis on underlying comorbidities, to ensure the protection of vulnerable communities and the navigation of this current crisis. J Gen Intern Med DOI: 10.1007/s11606-020-06264-5 © Society of General Internal Medicine 2020
INTRODUCTION
Coronavirus disease 2019 (COVID-19) is a global pandemic.1, 2 In the USA, the burden of COVID-19 morbidity and mortality has disproportionately fallen on minority and immigrant populations, exacerbating existing societal biases and longstanding racial/ethnic disparities in health.3, 4 Understanding these disparities in risk and outcome is of paramount importance. However, the understanding of the impact of this pandemic in AsianAmericans and Pacific Islanders (AAPIs) has been limited by inadequate data disaggregation, posing significant difficulties in the identification of vulnerable populations by ethnicity and Received June 3, 2020 Accepted September 21, 2020
socioeconomic group, and the subsequent allocations of resources for prevention and treatment.5
COVID-19 INFECTION AND MORTALITY IN ASIANAMERICANS
In aggregate, Asian-Americans represent 4.4% of deaths across the USA in the COVID-19 pandemic, below their population share of 5.7%.6 However, disaggregated data suggest far more complexity. In New York City, AsianAmericans account for 7.9% of deaths from COVID-19, while comprising 13.9% of the population.7, 8 Similarly in California, Asian-Americans make up 13.2% of deaths compared with 14.5% of the population.6 Yet disproportionate mortality rates have been noted i
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