Highest COVID hospitalizations came in majority Black, Latino areas, and places with low vaccination rates, analysis shows
Long Islanders in communities with low vaccination rates were far more likely to end up in the hospital with COVID-19 during the recent omicron surge than people who live in highly vaccinated ZIP codes, as were residents of majority Black and Latino areas, a Newsday analysis found.
People living in ZIP codes with the 50 lowest vaccination rates on Long Island were 39.4% more likely to be hospitalized with COVID-19 between Dec. 15 — when the omicron variant was becoming dominant in New York — and Feb. 28 than residents of the ZIP codes with the 50 highest vaccination rates, an analysis of state Department of Health data and U.S. Census Bureau population estimates shows.
"Those differences show how great science is, that the vaccine is quite effective," said Melody Goodman, associate dean for research and associate professor of biostatistics at the NYU School of Global Public Health in Manhattan.
Goodman wasn’t surprised by how residents of the 16 Long Island ZIP codes where Black and Latino residents are the majority were 24.4% more likely to be admitted to the hospital than residents of the other 160 ZIP codes. Health disparities that predated COVID-19, as well as more difficulty getting COVID-19 tests, and more potential exposure to the virus at work and at home, are among the reasons, she said.
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People who live in Long Island ZIP codes with the 50 highest vaccination rates were nearly 40% less likely to be hospitalized with COVID-19 during the recent surge than residents of the ZIP codes with the 50 lowest vaccination rates.
Residents of the 16 ZIP codes on Long Island with Black and Latino majorities were 24.4% more likely to be hospitalized than residents of other ZIP codes.
Experts say the data shows that vaccination is highly effective in keeping people out of the hospital, but that vaccination isn’t the only factor to explain why people of color are more likely to be hospitalized.
Vaccination rates in predominantly Black and Latino ZIP codes were lower than in the other ZIP codes: 70.6% versus 74.4% of all residents were considered fully vaccinated — two doses of the Pfizer-BioNTech or Moderna vaccine, or one of the Johnson & Johnson — as of Dec. 15, Newsday's analysis found.
Islandwide, the hospitalization rate was 4.35 hospital admissions per 1,000 residents for the 50 ZIP codes with the lowest vaccination rates, compared with 3.12 in ZIP codes with the highest rates.
People in the high-vaccination ZIP codes were less likely to be hospitalized during this winter’s surge than last winter’s, despite the far greater number of COVID-19 infections from omicron, while residents in the low-vaccination ZIP codes were more likely to be hospitalized.
Sean Clouston, an associate professor of public health at Stony Brook University, said that during the December 2020 holiday gatherings that helped spark last winter’s spike in hospitalizations, few New Yorkers were vaccinated.
This winter, the protection the vaccine offers is reflected in how people hospitalized with COVID-19 were on average younger than last winter, he said. That’s because vaccination rates are higher in older adults, Clouston said.
"Even though they’re older and more vulnerable, they’re going to the hospital much less commonly than sometimes younger, healthier, unvaccinated people," he said.
Gail Lynch-Bailey, 65, president of the Middle Island Civic Association, said older residents in her community tend to be vaccinated and boosted.
"I know several people [in Middle Island] who didn’t get vaxxed and are dead," she said. "They’re younger. They’re under 50."
Middle Island’s 11953 ZIP code, with a population of about 13,600, has among Long Island’s lowest vaccination rates, which Lynch-Bailey finds "confounding and heartbreaking."
She especially is saddened when she ponders the possibility that those who died of COVID-19 could be alive if they had only gotten the vaccine. "I think it just deepens my sorrow for them," Lynch-Bailey said.
The state does not have COVID-19 death information by ZIP code, health department spokeswoman Erin Silk said.
Middle Island’s hospitalization rate of 4.62 per 1,000 is nearly 50% higher than the rate in high-vaccination communities.
The ZIP code is about 65% white, non-Hispanic, 17% Black, 15% Latino and 2% Asian, according to the most recent census estimates.
Although ZIP codes with Black and Latino majorities on average had lower vaccination rates than the rest of the Island, most of the communities with the lowest vaccination rates were majority-white ones in Suffolk County, including Moriches, Mastic Beach and Shirley. And several of those had particularly high hospitalization rates.
Moriches' 11955 ZIP code, with only 50.4% of residents fully vaccinated on Dec. 15, had a hospitalization rate of 4.54. Brookhaven's 11719 ZIP code, with 62.5% of residents fully vaccinated, had a hospitalization rate of 9.57.
For the analysis, pre-pandemic population estimates were used to calculate vaccination and hospitalization rates, which could skew some numbers, especially in areas with significant pandemic-era population growth.
Long Island communities with lower vaccination rates — no matter their racial and ethnic makeup — tend to have a lower percentage of residents with college degrees and lower median incomes, an analysis of census data shows. That mirrors what surveys by the Pew Research Center and Kaiser Family Foundation have found nationwide.
The predominantly white Long Island communities with low vaccination rates also were more likely to have voted for former President Donald Trump in 2020. Pew and Kaiser found that Republicans are far less likely to be vaccinated than Democrats.
Studies consistently have shown that vaccination greatly reduces the chance of serious COVID-19 illness. Nationwide, an unvaccinated adult is 41 times more likely to die of COVID-19 than a fully vaccinated adult, and seven times more likely to be hospitalized, with even bigger gaps compared with those with booster shots, according to the Centers for Disease Control and Prevention.
Factors outside vaccination also influence who ends up in the hospital and help explain why hospitalization rates are higher in predominantly Black and Latino ZIP codes, said Martine Hackett, an associate professor of health professions at Hofstra University and an expert in health disparities.
"I think of this as an amplification of what we’ve been seeing throughout the pandemic, where communities of color are more susceptible to infection, hospitalization and death due to some of the underlying health conditions and because of the environment they’re in," she said.
The gap between Black and Latino majority ZIP codes and other ZIP codes was higher this winter than last winter, data shows.
Black and Latino people long have had higher rates of some diseases that are linked to more severe cases of COVID-19, Hackett said, and that in part is because they’re more likely to live in segregated neighborhoods with higher levels of poverty, less access to health care, more pollution and other factors that can lead to worse health outcomes.
Long-standing distrust of the health care system because of structural racism — along with the inability of some people of color to afford copays and other medical expenses — sometimes leads people to avoid seeing a doctor for diabetes, COVID-19 or other diseases until their situation worsens, making it more likely they’ll end up in the hospital, Assemb. Taylor Darling (D-Hempstead) said.
Darling's district includes Roosevelt, which has the largest percentage of Black and Latino residents on Long Island, 96%, and has one of only two majority-Black ZIP codes on the Island. It had a hospitalization rate of 4.6 per 1,000 and a vaccination rate of 62.5%, more than 11 points below the Islandwide average on Dec. 15 of 74.1%.
Eight to 10 miles west of Roosevelt, two other ZIP codes with Black and Latino majorities and lower-than-average vaccination rates also had high hospitalization rates: Inwood, at 5.38 per 1,000, and Valley Stream, at 5.21.
Goodman said the ability of people to get tested during the omicron wave, when there often were long lines for COVID-19 tests, also may have influenced hospitalization rates. Black and Latino people are more likely to have jobs in which they can’t ask a supervisor to take a long lunch or come in late to get tested, she said. Delays in getting tested can lead to not getting care that could prevent hospitalization, she said.
Darling said the jobs many of her constituents hold are public-facing ones, where the risk of infection is higher and where there’s no work-at-home option. And the homes they return to often are multigenerational, she said.
"You have a bunch of different people who are interacting with the community in different ways and then coming back home and interacting with each other," Darling said.
This winter’s surge saw the largest number of COVID-19 hospitalizations since spring 2020. Many initially were admitted for reasons other than COVID-19.
Hospitalizations climbed more quickly this winter than last winter, and they also dropped more precipitously. That’s in part because omicron infected so many people so quickly, that, along with vaccinations, meant the virus "hit a natural ceiling. It kind of ran out of people," Clouston said.
Even though the peak level of hospitalizations in January 2022 was much higher than in January 2021, the total number of COVID-19 hospitalizations from Dec. 15, 2021, to Feb. 28 — 11,141 — is only slightly higher than the 10,862 hospitalizations during the same period a year ago, because hospitalizations had fallen much lower by late February.