Even among Latinx Californians, COVID-19 risk is not evenly shared, analysis finds

COVID testing in Fruitvale

More than a year into the COVID-19 pandemic that upended life as we knew it, there’s still a lot we don’t know about how many people have fallen ill and exactly what has put some people – notably those who are Black or Latinx – at higher risk of infection and death.

A trio of studies from Epidemiology and Biostatistics researchers offers more detail about the risk factors that help explain higher rates of infection and death in these groups. An earlier paper, published in December in JAMA Internal Medicine, calculated excess deaths in California by age and racial grouping. A second study, released as a preprint a couple of weeks ago, the researchers list the California job sectors that saw the greatest jump in death rates between March and October of 2020.

In a third paper just published as a preprint, researchers led by first author Alicia Riley, PhD, and senior author Kirsten Bibbins-Domingo, PhD, MD, MAS, offer a deep dive into California’s Latinx population, with death rates broken out by age, country of birth, education level, and essential versus non-essential jobs.

All three papers drew their data from California death certificates and estimated the total deaths associated with the COVID-19 pandemic by comparing the number of deaths from March to October, 2020, to those that would have been expected without the pandemic (an estimate based on deaths over the past 4 years). Excess death rates may be a better measure of the true impact of COVID-19 than official COVID-19 death rates because bypass the differences in access various communities have had to testing.

The latest analysis offers the first consideration of differences within a demographic group, rather than between various groups. The analysis showed three distinct risk factors within the Latinx population: working in “essential” jobs, lacking a high school degree and being born outside the United States. The bump in risk for those born outside the U.S., and therefore more likely to be undocumented and/or monolingual, is big enough that U.S.-born Latinx people working in essential jobs experienced a proportionally smaller bump in excess mortality than non-U.S. born people who worked in non-essential jobs.

“Not all essential jobs are the same,” Riley explained. “’Essential’ includes such a huge range of roles.”

The risk of excess death among U.S.-born Latinx essential workers went up 21% during the pandemic, while the risk for non-essential workers born outside the U.S. rose 42%. Even more striking was the 57% increase in mortality observed among Latinx immigrants in essential jobs. Those without a high school degree and those who worked in the agricultural or manufacturing sectors also saw a relatively bigger jump in their risk of death.

These dramatic increases in excess death suggest that Latinos at highest risk are those who work undesirable jobs and have seen few workplace safety efforts to keep them safe. The data may also reflect the lack of effective public health messaging in Spanish and indigenous languages common among Latinx immigrants, Riley said.

“What we can see is that nothing about this was inevitable,” Riley said. “The variation tells us that the risk from the virus wasn’t randomly distributed. We need to learn from our mistakes and target interventions and vaccination distribution to those at highest risk.”