Racial disparities in flu mortality persist in many large U.S. cities

CHICAGO — As flu season approaches and the COVID-19 pandemic continues, public health officials are urging people to get a flu shot. Many communities of color are at higher risk of death from both influenza and COVID-19, says DePaul University health sciences faculty member Julia Lippert, and outcomes vary across the largest cities in the United States.

Lippert is a DePaul fellow with Sinai Urban Health Institute, as part of a collaboration on education, research projects, and development of programs that address social and health equity challenges. In this Q&A, she discusses her latest research with her colleagues published in the Journal of Racial and Ethnic Health Disparities, analyzing racial inequities in flu mortality across the 30 biggest U.S. cities.

Why is it important to look at city-level data for public health issues like flu mortality? There has been a push (albeit small) to provide city-level data as opposed to county or state because it can be used to develop more targeted interventions. Local trends are more difficult to discern through national and state-level data. The CDC has published research that shows city-level data is more effective in helping to develop and evaluate health policies. And the Sinai Urban Health Institute has published several studies analyzing the racial disparities at the city level for the leading causes of mortality.

Influenza and pneumonia are consistently within the top ten leading causes of death in the United States. We set out to assess racial inequities in mortality in the 30 biggest U.S. cities from 2009-2017. Public health researchers have established that many structural issues and social determinants of health contribute to the racial inequities in influenza and pneumonia mortality. Many of the same factors, including access to care, contributed to the racial health disparities we are seeing in COVID-19 mortality.

How are U.S. cities faring in addressing flu and pneumonia across racial demographics? Influenza and pneumonia mortality has decreased over time nationally and significantly in 13 of the 30 cities that we studied, including Chicago. And while we didn’t study this directly, progress can be attributed in large part to vaccination efforts. Nonetheless, there is a racial inequity in influenza and pneumonia mortality with significantly higher Black mortality rates in one third of the 30 largest U.S. cities.

For example, in Chicago, Black people are 18% more likely to die from pneumonia and influenza than white people. This racial inequity is decreasing in over half of the cities we studied, but only slightly. There are cities where this inequity remains largely the same or has increased over time. Chicago decreased in racial disparity but it was not statistically significant, meaning we have more work to do.

What can these findings, plus the learnings from the pandemic, teach us? What are the barriers to flu or COVID vaccination, as well as initiatives that work? Both the successes and failures of the COVID-19 pandemic as well as flu vaccination are linked to access to care. Having employers give you the day off so you can be vaccinated can reduce barriers. We have seen successful efforts to reduce vaccine hesitancy in the Black population, such as campaigns from the NAACP. As we’ve seen with COVID-19 vaccination efforts, often a mobilized response targeting people where they are can be most effective. Populations are not homogenous and that is why the city of Chicago has to offer a range of opportunities and resources, from educational outreach to bigger structural changes that make people’s default decision a healthy one. Requiring vaccinations — both for COVID-19 and the flu — can make a big difference.