Data shows undocumented Latinos face a disproportionate burden of long-COVID

New evidence shows that undocumented Latino immigrants, who make up 7% of the U.S. population, face significant challenges accessing health care due to high uninsured rates, limited access to primary care, language barriers and fears about their immigration status.¹ The study, conducted between May and December 2023 in 9 emergency departments (EDs) across the United States, aimed to understand the impact of long-COVID on this community.

Of 844 eligible patients, 818 participated in the study published in JAMA network opened. Among them, 136 were undocumented Latino immigrants, 160 were Latino residents and citizens (LRCs), and 522 were non-Latino LRCs. The study found that Latino undocumented immigrants were more likely to be uninsured and had less access to primary care compared to the other groups. Additionally, they had limited knowledge of Long COVID, with only 11.1% understanding the disease.

Comparing Long COVID Symptoms and Access to Care

The prevalence of long COVID symptoms was notable in all groups. However, undocumented Latino immigrants were disproportionately affected; 57.1% of undocumented Latino immigrants reported not going to work or school because of the condition. Meanwhile, these rates were lower in non-Latino LRCs (46.3%) and in Latino LRCs (35.7%). The authors noted that the lack of care for long-term COVID symptoms is particularly concerning: 60.0% of undocumented Latino immigrants reported not receiving care.

The study acknowledged that it focused on undocumented immigrants who identified as Latinx and therefore the results may not be applicable to other groups. It was also noted that the definition of long-COVID is still evolving and the definition accepted by the CDC at the time of writing was used.

“We recommend culturally relevant and translated resources and protocols in the emergency department to ensure access to diagnosis and follow-up care for long COVID,” the authors stated. “Future research that prioritizes the inclusion of undocumented people is needed to improve the applicability and generalizability of the results.”

Measuring the overall death rate during the pandemic

Additional research published in JAMA network opened showed that diverse and minority populations faced higher excess mortality rates during the COVID-19 public health emergency (PHE).²

Results from the cross-sectional study analyzing excess mortality from March 2020 to May 2023 highlighted significant racial and ethnic disparities. The investigation found that there were more than 1.38 million total deaths across the U.S. population, with a disproportionate impact on non-Hispanic American Indians or Alaska Natives and Hispanic populations. The observed to expected mortality ratio of 1.15 (95% CI: 1.12-1.18) corresponded to approximately 23 million years of potential life lost (YPLL).

The median age of those who died was 72.7 years, with 8.9% (944,318) of deaths being Hispanic, 0.7% (78,973) being non-Hispanic American Indian or Alaska Native, and 12.9% being non-Hispanic black (1,374). .228) of total deaths.

These groups had the highest observed-to-expected mortality rates, particularly among people aged 25 to 64 years. The American Indian or Alaska Native (AI/AN) and Hispanic groups in this age group had mortality rates of 1.45 and 1.40, respectively, well above the expected baseline.

Of note, AI/AN and Hispanic populations had the highest all-cause mortality rates across all age groups. The observed to expected mortality ratio for AI/AN individuals was 1.34 (95% CI: 1.31-1.37), while the ratio for Hispanic individuals was 1.31 (95% CI: 1.27-1 .34). These results suggest significantly higher mortality than would have been expected based on prepandemic trends in these populations.

Age-specific differences in excess mortality were most pronounced among working-age adults. Non-Hispanic blacks made up only 13.8% of the U.S. population under age 25, and yet they accounted for 51.1% of excess deaths in this age group during the study period. The study estimates that if the white population mortality rate had been applied to all racial and ethnic groups, more than 252,000 fewer deaths would have occurred – an 18.3% reduction in excess mortality. Additionally, the YPLL would have been cut by 5.2 million (22.3%).

“To prepare for future pandemics, efforts to protect high-risk populations—through the use of evidence-based policies, equitable distribution of resources, and improving infrastructure—are essential,” the authors write. “To achieve this, systemic factors must be addressed. In addition to preparedness, during emergencies (pandemics, natural or man-made disasters), just-in-time responses should target high-risk communities.”

References

1. Reyes KP, Rafique Z, Chinnock B, et al. Long COVID among undocumented Latino immigrants in the emergency room. JAMA Network Open. 2024;7(10):e2438806. doi:10.1001/jamanetworkopen.2024.38806

2. Faust JS, Renton B, Bongiovanni T, et al. Racial and ethnic disparities in age-specific all-cause mortality during the COVID-19 pandemic. JAMA Network Open. 2024;7(10):e2438918. doi:10.1001/jamanetworkopen.2024.38918