African-Americans Have a Higher Propensity for Death from COVID-19: Rationale and Causation

J Natl Black Nurses Assoc. 2020 Jul;31(1):1-12.


The purpose of this article is to provide an understanding about the mechanisms that contribute to the proliferation of COVID-19 morbidity and mortality among high-risk populations, and especially African-Americans. African-Americans are succumbing to novel SARS-CoV-2 (COVID-19) at an alarming rate. Current data indicate that while African-Americans represent less than 13.4% of the United States' population, they account for one-third of more than 4.77 million persons with verified COVID-19 infections. Currently, more than 50,258 African-Americans have succumbed to the disease. African-Americans are disproportionately impacted by COVID-19 to an extent unobserved in other racial/ethnic subgroups. In addition, this article describes the physiological event inflammation-mediation storming (cytokine storming). Social determinants of health such as income, education, and employment are hypothesized to impact cogent health care delivery for African-Americans. Included in this article are data on clinical outcomes that highlight the role of pre-existing (health disparities) conditions like diabetes, hypertension, cardiovascular disease, obesity, and lung disease, as barriers to optimal outcomes among African-Americans who are hospitalized with COVID-19. Also explored in this article is causation for vascular complications. A further aim of this article is to provide insight into cause and effect rationales for COVID-19 and health disparities, from both biosocial and health inequality perspectives. Linkages between these selected health disparities and COVID-19 are examined to determine possible deteriorating effects of COVID-19. Finally, techniques are offered to render culturally competent care to African-Americans diagnosed with COVID-19 who present concomitantly with health disparities.

Keywords: African Americans; COVID19; cytokine storm; health disparities.

MeSH terms

  • Black or African American / statistics & numerical data*
  • COVID-19
  • Coronavirus Infections / ethnology*
  • Coronavirus Infections / mortality*
  • Health Status Disparities*
  • Humans
  • Pandemics
  • Pneumonia, Viral / ethnology*
  • Pneumonia, Viral / mortality*
  • Social Determinants of Health / ethnology
  • United States / epidemiology