Co-Director Lynne Richardson, MD, left, and Director Carol Horowitz, MD, MPH, are guiding the new Institute for Health Equity Research. View an interview with Dr. Richardson on racial disparities and COVID-19.
The Mount Sinai Health System’s new Institute for Health Equity Research is quickly acting on its mandate to rigorously study disparities in health issues, including COVID-19, with the intention of translating those discoveries into initiatives and policies that benefit communities in New York and the nation.
“Our extensive expertise in population health and serving one of the most socioeconomically, demographically, and culturally varied populations in the world makes us uniquely positioned to take on this enormous challenge,” says Dennis S. Charney, MD, the Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai, and President for Academic Affairs of the Mount Sinai Health System.
The COVID-19 pandemic is shining a light on long-existing health inequities, according to the Institute’s Director, Carol Horowitz, MD, MPH, Professor of Population Health Science and Policy, and Medicine, and Dean for Gender Equity in Science, and its Co-Director, Lynne D. Richardson, MD, Professor and Vice Chair of Emergency Medicine, and Professor of Population Health Science and Policy.
“Who gets COVID-19, who lives and who dies, maps very well, unfortunately, with other kinds of maps we have in New York City,” Dr. Horowitz says. “This includes areas of poverty, areas of majority of low-income, Latinx, and African American people, areas of more pollution, areas of more linguistic isolation, areas that have had more redlining in the past and other structural inequities. If you look at any map of New York City, and where people are marginalized, don’t have equal opportunities, and have higher burdens of chronic diseases, these are the same areas where COVID-19 seems to be hitting the most.”
Initiatives in Progress
The Institute has a variety of initiatives in progress, including Speak Up on COVID-19, a survey that was just launched in partnership with more than 100 New York City community organizations. “Speak Up” will be available in 11 languages to anyone with access to a smartphone. It is seeking to enroll more than 10,000 participants and will explore medical, demographic, social determinants, and COVID-19-related attitudinal, behavioral, and psychological factors; and try to identify participants’ needs and risk-factors. The survey also offers a resource guide, Dr. Horowitz says, answering questions such as “What are the resources for food? What are the resources if you are a survivor of domestic violence, and you can’t get out of your house? What do you do if you are homeless? What do you do to help your kids learn? What do you do if you are pregnant and you have COVID-19?”
And studies are underway on subjects including:
- The impact of gender-affirming hormone treatment on the clinical course of COVID-19 in transgender and gender-nonbinary patients;
- Health outcomes for those living with HIV and COVID-19;
- How patient care via telehealth can be delivered equitably and narrow the digital divide.
The New York City Department of Health reports that 81 percent of COVID-19 cases are in the Bronx, Brooklyn, and Queens, with higher numbers in neighborhoods that are lower income and have more underserved residents. Only 12 percent of cases are in Manhattan, and there are signs of health disparity there as well, “right in our area, since The Mount Sinai Hospital is at the border of East Harlem and the Upper East Side,” Dr. Horowitz says. The DOH reports that as of May 18, in the 10029 zip code—East Harlem—there were 1,698 COVID-19 cases and 182 deaths, in a population that is 84 percent African-American and Latino with a median yearly income of $34,000. The toll was markedly lower in the adjacent 10028 zip code—the Upper East Side—where there were 603 cases of COVID-19 and 34 deaths, in a population that is 71 percent non-Hispanic white with a median income of $114,000.
The Mount Sinai Health System is well positioned to collect and study its own data on health care disparity because of years of groundwork led by the Office for Diversity and Inclusion, says Gary C. Butts, MD, Chief Diversity and Inclusion Officer, Mount Sinai Health System, and Dean for Diversity Programs, Policy, and Community Affairs, Icahn School of Medicine. “Understanding disproportionality is important,” Dr. Butts says. “With the data we have assembled, we can study it better, and we can be positioned to close the gaps that we have been talking about for a long time. It’s the right thing to do, and it’s the smart thing to do.”
Collecting Data
Pamela Y. Abner, MPA, Vice President and Chief Administrative Officer, Office for Diversity and Inclusion, spearheaded the effort to make it a standard procedure across most of the Health System to collect data in Mount Sinai’s patient registration systems on race, ethnicity, language, and sexual orientation and gender identity. The data are available to clinicians and researchers to enhance patient care and further study on an innovative Disparities Dashboard, created with leaders including Dr. Richardson and Nina A. Bickell, MD, MPH, Professor of Population Health Science and Policy, and Medicine.
“In the case of COVID-19, it appears that African-American patients were coming into the hospital sicker,” says Ms. Abner, citing preliminary findings. “We will now be able to analyze our data to determine if there are socioeconomic factors that impact outcomes within our most vulnerable populations. For example, we might look at the relationship between race/ethnicity and those who were more acutely ill, based on ICU numbers or length of stay, and consider how that may have impacted clinical outcomes.”
Dr. Richardson has experienced the toll of the COVID-19 pandemic more directly than most. In addition to her administrative and research duties, she treats patients in the Emergency Department at The Mount Sinai Hospital and at Elmhurst Hospital, and recently recovered from COVID-19 herself. “Now that we have come through the worst of the COVID-19 pandemic, it is important that we thoroughly investigate all of the causes of its disproportionate impact on racial/ethnic minorities and vulnerable communities, which are layered on top of many longstanding, pre-existing health and health care disparities,” Dr. Richardson says.
The overarching goal is addressing needs of populations at risk of COVID-19 and other health issues, which includes many members of the Mount Sinai community. “Mount Sinai is the biggest employer in East Harlem,” Dr. Horowitz says. “These are the people who are delivering food, delivering medicine, driving people around, working as home attendants. These are heroes; these are the people who have not stopped. They are not staying home in isolation, because they can’t.”
“At this point, our ability to understand, partner with, and serve those who are most vulnerable to COVID-19 is a reflection of our commitment as human beings, as researchers, as clinicians and as a Health System,” Dr. Horowitz says. “We are only as good as how we care for our most vulnerable populations.”