{"id":868,"date":"2020-11-25T08:13:23","date_gmt":"2020-11-25T13:13:23","guid":{"rendered":"https:\/\/covidqanda.org\/?p=868"},"modified":"2020-11-25T08:15:12","modified_gmt":"2020-11-25T13:15:12","slug":"which-measure-of-disparity-is-correct","status":"publish","type":"post","link":"https:\/\/covidqanda.org\/?p=868","title":{"rendered":"Which measure of disparity is correct?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><em>Happy Thanksgiving!&nbsp; Q&amp;As will resume on Monday, November 30th.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><span style=\"text-decoration: underline;\">Question:<\/span><\/strong>&nbsp;Yesterday you mentioned that Black American COVID patients are 1.24x more likely to die than White American COVID patients.&nbsp; I thought the rate was much higher than that.&nbsp;This <a href=\"https:\/\/www.apmresearchlab.org\/covid\/deaths-by-race\">APM Research Lab analysis<\/a> shows that compared with Whites (and adjusting for age), Blacks have 3x higher mortality.&nbsp; Which is correct?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><span style=\"text-decoration: underline;\">Answer:<\/span><\/strong>&nbsp;To my knowledge, both numbers&#8211;terrible as they are&#8211; are correct.  The APM number is based on the COVID <strong>cumulative&nbsp;mortality rate<\/strong> (deaths\/100,000 population) whereas the number I cited is based on the <strong>August case fatality rate <\/strong>(deaths\/cases).&nbsp; Racial disparities in mortality&nbsp;rates are primarily driven by: 1) disparities in who is getting infected; and 2) disparities in who succumbs to the disease.&nbsp; It&#8217;s this second piece&#8211; disparities in who succumbs to the disease&#8211; that the case fatality&nbsp;<a href=\"https:\/\/www.medrxiv.org\/content\/10.1101\/2020.11.15.20232066v2\">analysis<\/a> I described yesterday helps disentangle.&nbsp; &nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For example, APM&#8217;s analysis shows that Asians have the same overall mortality as Whites.  Our case fatality analysis, however, shows that Asians have higher case fatality than Whites (1.19x higher in August*).&nbsp; This disparity was masked in the overall mortality rate.&nbsp; Why?&nbsp; Because Asians have been less likely than other racial\/ethnic groups to become infected with COVID, but more likely (particularly in older age bands) to succumb to COVID if they become infected.  This is a great example of why it&#8217;s important to look at case fatality rates alongside mortality rates.**<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Finally, since we&#8217;re talking about race and health outcomes, I&#8217;ll remind us all that race has no genetic basis and is a social construct (see <a href=\"https:\/\/covidqanda.org\/?p=448\">Q&amp;A of 6\/7<\/a>).&nbsp; Stark differences in mortality by race are stark markers of inequalities by race.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">*Note: I haven&#8217;t re-run the analysis, but to my\u00a0recollection, the cumulative case fatality rate among Asians is nearly 1.7x higher than the rate among Whites.       <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">**Note: If you ever want to learn more about different mortality frequency measures, <a href=\"https:\/\/www.cdc.gov\/csels\/dsepd\/ss1978\/lesson3\/section3.html\">CDC&#8217;s Principles of Epidemiology in Public Health<\/a>\u00a0is a great resource.\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Happy Thanksgiving!&nbsp; Q&amp;As will resume on Monday, November 30th. Question:&nbsp;Yesterday you mentioned that Black American COVID patients are 1.24x more likely to die than White American COVID patients.&nbsp; I thought the rate was much higher than that.&nbsp;This APM Research Lab analysis shows that compared with Whites (and adjusting for age), Blacks have 3x higher mortality.&nbsp; [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":869,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[93,22],"tags":[105,128],"class_list":["post-868","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-models","category-mortality","tag-race","tag-racism","fallback-thumbnail"],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/i0.wp.com\/covidqanda.org\/wp-content\/uploads\/2020\/11\/pexels-photo-236380-1.jpeg?fit=1880%2C1245&ssl=1","_links":{"self":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/868","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=868"}],"version-history":[{"count":3,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/868\/revisions"}],"predecessor-version":[{"id":872,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/868\/revisions\/872"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/media\/869"}],"wp:attachment":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=868"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=868"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=868"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}