ESPE Yearbook of Paediatric Endocrinology

Cell Metab. 2021 Mar 2;33(3):473–478. doi: 10.1016/j.cmet.2021.02.006. PMID: 33581046.

In brief: This perspective paper discusses the observed disparities for metabolic diseases in regard to COVID-19. Disparities stem from systemic differences in access to care, environmental exposures and other sociodemographic factors.

Comment: Hopefully, by the time these lines are published, the COVID-19 pandemic will have calmed down and the world will have returned to normality. Nonetheless, lessons need to be learned from this global event. Over the course of the pandemic, it became evident that increasing age, diabetes, obesity, cardiovascular disease, chronic kidney disease and male gender are strongly associated with worse severity of COVID-19 and consequent mortality. The disproportionate effect of COVID-19 on racial minorities also became clear. The mortality ratio was > 3x higher in Black than White populations in the US.

Although Black individuals represent only 31% of US health system users, they represented 70% of patients with COVID-19. Black COVID-19 patients had greater prevalences of metabolic diseases including obesity, diabetes, hypertension and chronic kidney diseases than did White COVID-19 ppatients. However, after adjustment for differences in sociodemographic factors and comorbidities, Black race was not associated with higher in-hospital all-cause mortality.

This study showed that mortality from COVID-19 is not directly influenced by race, but rather by related factors, such as sociodemographic factors, health care access, occupational COVID-19 exposure, and long-standing disparities in nutrition, obesity and the metabolic syndrome. As the world becomes smaller, further viral pandemics are expected. This study highlights the need to improve health equity.