Lisa A. Newman, Robert A. Winn and John M. Carethers
DOI: 10.1158/1078-0432.CCR-20-3421 Published January 2021
Coronavirus disease 2019 (COVID-19) is a novel infectious disease that has spread worldwide. In the United States, COVID-19 disproportionately affects racial and ethnic minorities, particularly African Americans, with an observed 2-fold higher rate for hospitalization and greater than 2-fold higher rate for death as compared with White Americans. The disparity seen with COVID-19 is consistent with patterns of disparities observed for cancer; it is well documented that 5-year survival rates for multiple cancers are lower in African Americans compared with White Americans. Root cause contributions for the disparity overlap between COVID-19 and cancer. While cancer is a genetic disease that is influenced by tissue microenvironment, COVID-19 is an infectious disease that is enabled by cellular expression of angiotensin-converting enzyme 2 receptors. However, socioeconomic disadvantages, level of education, lifestyle factors, health comorbidities, and limited access to medical care appear to fuel underlying risk for both cancer and COVID-19 disparities. In addition to African Americans demonstrating higher risk of acquiring and dying from either disease, they are underrepresented in clinical trials involving cancer or COVID-19. Long-term disparities are present with survivorship from cancer and may be likely with survivorship from COVID-19; both have revealed untoward effects on postdiagnosis economic viability for African Americans. Collaborative strategies that include community engagement, diverse participation in cancer and COVID-19 clinical trials, providing insurance for affected persons who lost employment due to either disease, and supporting safety-net and public hospitals for health care access will be critical to stem these disparities.
Documented disparities in cancer incidence and mortality for racial and ethnic minorities and the medically underserved appear to be replicated with infection and survival outcome from coronavirus disease 2019 (COVID-19); the similarities are striking, with the underpinnings rooted in systemic structural socioeconomic disadvantages. Implementation of strategies to alleviate both cancer and COVID-19 disparities through governmental advocacy and action, hospital and community involvement, and provider and researcher participation must be proactively undertaken as a public health imperative. Adequate representation of racial and ethnic minorities in both cancer clinical trials and COVID-19 vaccine trials will boost confidence within those communities for uniform acceptance of results, enhance future clinical trial participation based on partnerships with the communities, and improve overall medical long-term compliance.
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