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David Wohl, MD, and Jessie Edwards, PhD

COVID-19 has become a leading cause of death and reduced life expectancy in the U.S., especially among Black and Latino populations. David Wohl, MD, member of the Institute for Global Health & Infectious Diseases and professor of medicine in infectious diseases, and first author Jessie Edwards, PhD, assistant professor in the department of epidemiology at the Gillings School of Global Public Health, examined the cumulative probability of dying at home from COVID-19 in a new study published in Open Forum Infectious Diseases. They also examined the excess risk of dying at home due to any cause during the pandemic, compared to expected at-home mortality, and the differences in this risk by demographic characteristics, including race and ethnicity.

Using death certificate data between March 1, 2020 and December 31, 2021, the researchers determined that of the 22,646 deaths due to COVID-19 recorded in North Carolina, 7.8% occurred at home. Like COVID-19 deaths in general, most COVID-19 deaths at home were among those older than 70 years of age. However, 42% of at-home COVID-19 deaths occurred among those under 70 years of age compared to 36% of all COVID-19 deaths. The risk of dying at home with COVID-19 was greater among Hispanic and Black people compared to White people. The risk of at-home COVID-19 death for both Hispanic and Black individuals was at least double that of White individuals. Rates of dying at home from any cause increased overall but were greatest among Hispanic people.

“Our findings suggest that during the pandemic people of color in North Carolina have been confronted by greater obstacles to accessing and utilizing urgently needed healthcare than others. Given what we know about health disparities in the US, it is very likely this is not confided to our state or even our region,” Dr. Wohl says.

Pandemic-related hurdles likely exacerbated perennial barriers to healthcare including lack of health insurance and transportation that disproportionately effect people of color, those with fewer financial resources, and the undocumented—populations who are also disproportionately at risk for SARS-CoV-2 infection, Drs. Edwards and Wohl note in their paper.

Approaches that remove these barriers, extend healthcare access, and encourage healthcare seeking behaviors, particularly for those disproportionately impacted by both COVID-19 and impediments to healthcare, are needed to avoid preventable deaths.

The study can be accessed here.