As manager of the Southern Nevada Health District’s Office of Chronic Disease Prevention and Health Promotion, Maria Azzarelli works with local governments and community partners to prevent chronic disease — something that impacts and kills some demographic groups more than others.
When it comes to chronic disease in Clark County, black residents are hit hardest. They have the highest rates of heart disease, diabetes, high blood pressure, high cholesterol, smoking and strokes, according to a 2017 report from the health district.
So when Azzarelli heard that black residents in Clark County faced an above-average COVID-19 death rate, she unfortunately wasn’t surprised. Years of unequal access to health care and health resources have led to higher rates of underlying health conditions in blacks, which in turn put them at greater risk of complications from COVID-19.
“In these populations, there’s less access to healthy food. There’s economic disadvantage, and oftentimes people of lower socioeconomic status live in food deserts,” Azzarelli said.
On April 17, the health district began releasing the races and ethnicities of residents who died from COVID-19. The data has been updated continuously to paint an even clearer picture: As of Monday, 18.58% of people in Clark County who died from COVID-19 were black, even though black residents make up just 12.21% of the county’s population.
The trend is similar in communities across the country. An analysis by American Public Media last updated on Tuesday found that the nationwide death rate from COVID-19 for blacks was 37.2 per 100,000 residents, more than the double the rate seen in any other racial or ethnic group.
Socioeconomic factors, poor access to health care, a legacy of racist policies and varied immune responses to the disease between demographic groups are all possible factors nationwide and in Clark County, according to Las Vegas doctors, public health experts and community leaders.
But local factors might be at play as well. These include the underfunding of public health programs dedicated to chronic disease prevention in Nevada and the geographic distribution of testing sites and health care facilities, some experts and advocates say.
Follow the money
The Office of Chronic Disease Prevention and Health Promotion helps stakeholders develop policies proven to reduce the risk of chronic disease, Azzarelli said. The department also has a website that directs residents to accessible health resources in their community.
But the department can only do so much with limited funding in Nevada for public health, Azzarelli says.
Nevada ranked last for per-capita public health funding in a 2019 report from the United Health Foundation. Directing more state money toward public health efforts could reduce some of the health disparities in Clark County, including the disparities in the COVID-19 death rate, Azzarelli said.
“There’s very, very little in terms of state general fund dollars going to public health, and we could definitely use more of it,” she said. “Then, ultimately, we (would) see a reduction in these health disparities.”
The limited resources that exist in Clark County are not evenly distributed across the valley, often putting blacks at a further disadvantage for health care, said Melva Thompson-Robinson, UNLV professor of public health and executive director of the Center for Health Disparities Research. That contributes to the high rates of preexisting conditions among African Americans, and possibly the high rate of COVID-19 deaths as well, she said.
“One of the things that the pandemic has shown is that those communities in particular don’t have access to the resources that are needed,” she said.
According to the U.S. Health Resources and Services Administration, much of North Las Vegas, central Las Vegas, West Las Vegas and east Las Vegas are considered medically underserved areas. They are designated as such by having too few primary care providers, high infant mortality rates, high levels of poverty or many elderly residents.
All four of those communities have large minority populations, and many of them have high rates of COVID-19 as well, according to health district data.
“It’s easy to say, ‘Go see your doctor if you’re having symptoms,’ but if you don’t have a primary care physician or primary care provider, then it’s very hard to do that,” Thompson-Robinson said.
Testing for COVID-19 has also not been widely available in communities with large black populations, said Roxann McCoy, president of Las Vegas’ chapter of the NAACP. Especially for black residents of lower incomes, traveling to a free test site such as the one at UNLV School of Medicine might not have been feasible, McCoy said. Some of the test sites only accept people via car, creating another barrier.
“Maybe you didn’t have transportation to do the drive-thrus, or you didn’t have the resources to get the testing,” McCoy said.
Fortunately, access to testing has improved in the last few weeks, McCoy said. The health district has begun targeted community testing in areas with high rates of COVID-19 and with large populations at risk of complications, including the elderly and those with preexisting conditions, said Dr. Michael Johnson, director of the health district’s community health division.
Last weekend, the health district set up a testing site at Canyon Springs High School, and the weekend before, officials did the same thing at multiple senior centers in North Las Vegas, Johnson said.
McCoy hopes the new testing sites will help officials better understand the scope of the pandemic in black communities. It could also help with a longstanding issue in these communities, Thompson-Robinson said: Distrust of medical professionals and government officials due to the legacy of racism.
“We have to figure out where we begin to mitigate those damages, and in order to do so, we have to start coming to the people where they are instead of having them coming to us,” McCoy said.
Med school dean: Biological factors also possible
Not all health officials agree on the extent to which resource allocation and socioeconomic factors are driving the relatively high COVID-19 death rate for black residents. Because the local COVID-19 infection rate for this population does not appear to be disproportionately high, Dr. Marc J. Kahn, dean of the UNLV School of Medicine, suspects that biological factors might be more significant in Clark County.
Much about how COVID-19 behaves and affects people remains unknown, but it appears that people exhibit a wide variety of immune system responses to the disease, perhaps based on biological differences, Kahn said.
“When we look at what is causing death in COVID-19, some of the lung damage we see later in the disease is really related to an immune system that can be thought of as being overactive,” Kahn said. “Similarly, some patients don’t clear the virus and have what some might call a weaker immune system, and that can also lead to organ damage.”
But biological factors aren’t something that can be easily addressed, Kahn said, at least not in the short-term and not necessarily by local officials. Access to health care and chronic disease rates, however, can be prioritized.
If more Americans of all racial and ethnic groups could access health care in a way that was convenient and affordable, underlying health conditions could be identified much sooner, or even prevented, he said. People who did contract COVID-19 might also be inclined to see a doctor when their symptoms were still mild, possibly reducing fatalities.
“One of the things a pandemic like this illustrates is a need for a better health care system to the benefit of all of the nation’s citizens, not just a select few,” Kahn said.
With African Americans more likely to work in low-wage jobs than their white counterparts, often because of unequal educational opportunities, health insurance and care can be particularly inaccessible to them, Thompson-Robinson said. Low-wage jobs are less likely to offer employee-sponsored health insurance.
“Down the road, that leads to poor health status,” she said.
Some disparities not yet fully studied
As the COVID-19 pandemic continues to impact Southern Nevada, another demographic disparity needs further research, health officials say: the disproportionately high death rate among Asians in Las Vegas.
Like black residents, Asian residents aren’t getting infected at higher rates. But, despite representing 10.51% of Clark County’s population, they made up 16.81% of COVID-19 deaths as of Monday.
The trend does not appear to be widespread nationwide, as is the case with the death rate for black residents. In addition, Asians in Clark County do not have as high poverty rates as black residents, nor do they have the same rates of preexisting health conditions.
Therefore, a lot of what public health officials know about the death rate among Clark County’s Asian residents remains “speculation,” Thompson-Robinson said.
“We don’t have a full understanding of why this is right now,” Azzarelli said.
One factor that could be driving the trend is the high rate of smoking among Asian populations, particularly Asian men, Johnson said. But because the region’s Asian population is highly diverse, comprising Chinese, Japanese, Filipino, Thai and other ethnic groups, it is difficult for the health district to speculate on causes and appropriate interventions, Azzarelli said.
It also remains unclear why Latinos in Southern Nevada haven’t been dying at higher rates of the disease, especially considering that has been observed in some other U.S. communities.
“That’s something that has to be examined,” Azzarelli said. “Is our Hispanic population somehow different than Hispanic populations around the United States? We’re not sure.”
Perhaps the silver lining to all this is that more people will begin to understand and address Las Vegas’ health disparities that have existed since before the pandemic began, McCoy said.
“No group of people should be disproportionately affected in this day and time,” McCoy said. “The issue is continuing to remain, and the issue is continuing to get worse. It’s not like it’s going away.”