It has been well documented that the COVID-19 pandemic disproportionately affects patients from racial and ethnic minority groups. But how do these disparities manifest in patients, and what factors drive them?

A study by imaging researchers at Massachusetts General Hospital is helping to shed some light on this question by looking at patient chest x-rays.

The study, which was recently published in the journal Radiology, was co-led by Nicholos Joseph and Nicholas Reid of Harvard Medical School and Mass General radiologist Efren J. Flores, MD.

Here are five things to know:

The team studied imaging data from 326 patients hospitalized with confirmed COVID-19 infections at Mass General between March 27 and April 10. The study included patients who received chest X-rays at the time of evaluation for COVID-19 symptoms, including patients at the hospital and at a respiratory clinic in Chelsea, a city north of Boston with a high proportion of Spanish-speakers.

They found that Non-White patients were significantly more likely to show severe disease in chest X-rays compared to white/Non-Hispanic patients. This severity was linked to an increased likelihood of worse outcomes, including admission to the intensive care unit, intubation and death. Non-White patients were also hospitalized at higher rates than usual during the study period.

The team identified several factors contributing to this disparity, including:

Barriers to Accessing Healthcare: Limited English proficiency and lower socioeconomic status creates challenges in navigating the healthcare system.

Living Arrangements:  Non-White patients in the study tended to live in multigenerational households and in communities with higher population densities, allowing the virus to spread easily among individuals. 

Employment: Non-White patients were more likely to have jobs as essential workers, which usually do not have a work-from-home option, increasing their potential exposure to the disease.

“Many of these patients delay their care because they’re considered essential workers and they don’t have a lot of sick leave, but also it’s difficult for them to leave because they are living on a weekly paycheck and have other dependents,” Dr. Flores said. “It wasn’t uncommon for us to go into the medical record when we were interpreting their exams and see that many of them worked at grocery stores or warehouses.”

The team’s findings could help to better identify vulnerable and at-risk populations and develop community-based strategies to reduce the disproportionate impact of the disease. “We did this study not only to gain a better understanding of these emerging disparities, but also to discover how we can use this information to craft a better path toward equity together,” says Flores.

Study Limitations

The team cautions that their study only covered COVID-19 cases at Mass General over the span of a month, and the results may not apply to other patient populations or geographic areas. It is also possible that Mass General received a higher number of severe cases than other hospitals. Other factors that contribute to disease severity, such as co-occurring health conditions, may not have been completely captured in patients’ self-reported medical histories.

Further research could help to address these and other limitations.

COVID-19 Research at Mass General
Researchers and clinicians at Massachusetts General Hospital Research Institute are mobilizing to develop new strategies to diagnose, treat and prevent COVID-19. Learn more.