Covid Era Disparities Survey | 2022 Annual Report

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Fielded online in October 2022 by Morning Consult, the personal experiences of over 3,800 surveyed Americans show a variety of differences by race and ethnicity in the pandemic’s impact on their well-being, as well as the factors that contributed to those effects.
Survey data show disparate impact of factors affecting Americans’ health during pandemic
The COVID-19 pandemic has had a profound impact on all Americans, from physical and mental health to clinical care and economic resources to social support and engagement. America’s Health Rankings has found concerning disparities by race/ethnicity across a broad array of measures as pandemic-era data have been released. The effects of the pandemic have not entirely subsided — it continues to affect the daily lives of Americans and many aspects of their health and well-being.
To better understand the racial/ethnic health disparities experienced across these categories during the pandemic, America’s Health Rankings launched the COVID-era Disparities Survey in partnership with Morning Consult. The survey, conducted via internet panel, polled a total of 3,849 U.S. adults ages 18 and older, with oversamples of American Indian/Alaska Native, Asian, Black, Hispanic and Hawaiian/Pacific Islander populations. Each of the surveyed groups was weighted based on age, gender, race/ethnicity, education and region. Along with the quantitative portion of the survey, respondents provided personal perspectives in their own words to illustrate how their and their families’ health was impacted during this challenging time. 
Nearly 1/3 of Black and Hispanic adults lost a close friend or family member as a result of COVID-19
As premature death spiked during the COVID-19 pandemic, and racial disparities widened, the impact of deaths related to COVID-19 was felt unequally between racial groups. According to survey results, Black (32%), Hispanic (31%), American Indian/Alaska Native (26%) and Hawaiian/Pacific Islander (26%) adults were significantly more likely than white (19%) and Asian (15%) adults to report losing a family member as a result of COVID-19. Similarly, 32% of Black adults and 28% of Hispanic adults reported losing a close friend, compared with 21% of white adults and 14% of Asian adults. American Indian/Alaska Native (26%) and Hawaiian/Pacific Islander (27%) adults were also more likely to have lost a close friend compared with Asian adults.

“I felt a lot more anxious and unsure about what might happen to my loved ones, so that took a toll on me.” 
– 26-year-old Hispanic male from Texas
“During the early part of the pandemic, I knew people who were hospitalized because they contracted COVID-19 so I was always very worried.” 
– 69-year-old Black female from New York
Many adults delayed care during the pandemic; American Indian/Alaska Native and Hawaiian/Pacific Islander adults more likely to have not yet caught up
The survey found differences by race/ethnicity in those who delayed receiving care over the course of the pandemic. Hispanic (52%), Hawaiian/Pacific Islander (51%), American Indian/Alaska Native (50%) and Asian (49%) adults had higher rates of delaying care compared with Black adults (42%). The rate was also significantly higher among Hispanic adults than white adults (46%).
Adults surveyed who reported delaying care were asked to select which factors most influenced the delay of needed care.1 Among those who reported delaying medical care, nearly half of Hawaiian/Pacific Islander adults (49%) cited difficulty getting an appointment, compared with 23% of Black adults, 27% of Asian adults, 28% of Hispanic adults and 34% of white adults. Of those who reported delaying care, Hawaiian/Pacific Islander (32%) and American Indian/Alaska Native (30%) adults had higher rates of not yet being caught up on that postponed care, compared with 20% of Black adults and 21% of Asian adults who delayed care. White adults (26%) also had a higher rate of not being caught up compared with Black adults.
“There are so many others whom I know and those I never will who were so very greatly impacted in many ways by the COVID-19 pandemic. COVID-19 touched my life in a drastic way...” 
– 69-year-old Pacific Islander female from Arkansas
Mental health especially impacted by occupational stress, financial issues and social isolation
Beyond the direct health impact of the disease itself, respondents identified the indirect economic implications of the pandemic as a major factor affecting their well-being. Across all racial and ethnic groups surveyed, job/occupational stress (excluding job loss), financial issues and social isolation were the factors that most negatively impacted mental health during the COVID-19 pandemic. Over half of Hawaiian/Pacific Islander adults (56%) and 50% of Hispanic adults reported that job/occupational stress had a negative impact on their mental health, compared with 39% of white and Black adults, 46% of American Indian/Alaska Native adults and 45% of Asian adults. Relatedly, Hawaiian/Pacific Islander adults and American Indian/Alaska Native adults (both 59%), Hispanic adults (58%), white adults (54%) and Black adults (51%) reported financial issues negatively impacted their mental health during the pandemic at higher rates compared with Asian adults (46%). Hispanic adults (54%) reported that social isolation negatively impacted their mental health at a higher rate than Asian adults (47%).
“[The pandemic was] exhausting and draining and difficult for families with school-age children.”  
– 42-year-old Black female from New York
The survey found that lower-income adults (annual household income under $50,000) were more likely than those in the same racial/ethnic group with a higher income (annual household income $50,000 or higher) to say their mental health was worse at the time of the survey compared to prior to the pandemic. For example, 38% of white adults and 32% of Hispanic adults with incomes less than $50,000 said their mental health is worse now than before the pandemic, compared with 24% of white adults and 21% of Hispanic adults with incomes more than $100,000.
Continued impact of social isolation varies by race/ethnicity, with differences in contributing factors
Social isolation remained a challenge for many Americans at the time of the survey. Hawaiian/Pacific Islander (17%) and Hispanic (16%) adults reported higher rates of feeling much more socially isolated from family and friends now versus prior to the pandemic, compared with Black and Asian adults (both 9%) and American Indian/Alaska Native adults (10%).

“The simple fact that I couldn’t partake in going outside or to my local restaurants and bars or interact with humans in general took a toll on both mental/physical and social/financials.”  
– 38-year-old Hawaiian/Pacific Islander male from Illinois
The survey results highlight how the factors that contributed to social isolation during the first year of the pandemic varied by racial/ethnic groups.2 However, not being able to engage in regular activities and not being able to see friends and family in person were consistently reported as the most impactful factors across groups. A higher percentage of Asian adults reported that not being able to travel (69%) influenced their feeling of social isolation a lot or some, compared with all other racial/ethnic groups. Black (50%) and Hawaiian/Pacific Islander (47%) adults reported that not being able to attend church/spiritual events influenced their feelings of social isolation a lot or some at a higher rate than most other racial/ethnic groups. 
Overall, roughly 3 in 5 adults said more time with family members (59%), new hobbies and activities (59%), social media (58%), and audio and video calling (57%) helped lessen social isolation a lot or some during the pandemic. There were some differences by race/ethnicity, as a higher percentage of Black adults (63%) said using social media helped lessen social isolation a lot or some compared with white (55%), Hispanic (58%) and American Indian/Alaska Native adults (46%). 67% of Asian adults, 65% of Black adults and 62% of Hispanic adults said audio and video calling helped lessen social isolation, which was a higher rate than among white (55%) and American Indian/Alaska Native (49%) adults.
“The pandemic was a hit on a lot of aspects of life, but it also made me rethink everything, be appreciative of basic things, and…become a stronger individual.”  
– 26-year-old Asian male from Ohio
Higher-income and white adults more likely to have resumed pre-pandemic activities
Nearly 4 in 10 white adults (38%) reported that they have resumed all social activities that they engaged in before the pandemic, a higher rate than among Hispanic (31%), Black (28%), Asian (24%) and Hawaiian/Pacific Islander (25%) adults surveyed. Within racial/ethnic groups, adults with higher household incomes were more likely to have resumed their pre-pandemic activities than those with lower incomes. For example, 82% of Hispanic and 89% of Asian adults with incomes more than $100,000 have resumed activities, compared to 72% of Hispanic and 74% of Asian adults with incomes less than $50,000.
Reasons for not resuming pre-pandemic activities varied. Overall, adults surveyed in the general population who have not returned to all social activities were most worried about getting or spreading COVID-19 or other infectious diseases (43%) and financial barriers (38%). Mental or physical barriers were cited most often among white (29%) and Hispanic (26%) adults compared with Black (19%) and Asian (17%) adults. Meanwhile, American Indian/Alaska Natives who have not returned to all social activities were more likely to report feeling disconnected from programs or people they were once connected to (36%), compared with Black and Asian (both 25%) adults surveyed.
“I feel very disconnected to anyone in my past that was once connected to me.”  
– 55-year-old American Indian/Alaska Native male from Texas
Addressing inequities and understanding sources of trust as leaders look ahead
As policymakers and health officials seek to recover from the pandemic and prepare the country for the next public health emergency, the COVID-era Disparities Survey findings highlight the importance of addressing the inequities affecting different racial/ethnic groups that may have contributed to their experiences during COVID-19. It is also important to recognize the varying levels of trust that Americans have in different health authorities and institutions that shape their health care.
Respondents of all racial and ethnic populations expressed a high level of trust in primary care providers. Overall, 82% of adults said they place a lot (49%) or some (33%) trust in their primary care provider for information related to their personal and family’s health. Three-fourths of the general population surveyed also place a lot or some trust in hospitals (76%), friends and family (75%) and local pharmacists (75%). Respondents expressed lower levels of trust in other messengers: about 18% of adults surveyed trust state and local public health officials a lot and 39% trust them some, and only 7% of adults said they trust the news media a lot (32% trust them some). Communicating and disseminating health information through trusted sources — especially the providers who play a close and crucial role in patient care and education — and rebuilding trust in others will be important to consider when planning for the future.3

COVID-era Disparities Survey Methodology
The COVID-era Disparities Survey was conducted by Morning Consult on behalf of the United Health Foundation to understand the COVID-19 pandemic’s effect across racial and ethnic groups. The survey was conducted online October 12-23, 2022 among U.S. adults. Six independent samples were collected: one for the general population and separate samples for specific racial/ethnic groups. Survey respondents self-reported their race/ethnicity. For comparison within the report, white non-Hispanic adults were a subset of the general population data. 
Sample sizes and margins of error (MOE):
General population: n=1,000, MOE= +/- 3 percentage points
Hispanic adults: n=800, MOE= +/- 3 percentage points
Black adults: n=800, MOE= +/- 3 percentage points
Asian American adults: n=800, MOE= +/- 3  percentage points
American Indian/Alaska Native adults: n=250, MOE= +/- 6  percentage points
Native Hawaiian or Other Pacific Islander adults: n=199, MOE= +/- 7  percentage points
Each of the samples surveyed was weighted based on age, gender, race/ethnicity, education and region. Throughout the analysis, significance testing was run to identify significant differences across racial and ethnic groups. To test for statistically significant differences between responses, the quality of proportions was set with an alpha level at 0.05 (5%). 
A full description of the COVID-era Disparities Survey methodology is included in the Annual Report.


 1 Options in the survey included: Worried about contracting COVID-19 at the facility, Difficulty getting an appointment, Facility was closed, Cost-related barriers, Difficulty finding a physician or other healthcare provider who would see me, Lack of access to transportation, Uninsured/high copay, No insurance coverage, Not enough time, Barriers related to telehealth or virtual appointments, Moved during the COVID-19 pandemic and did not have a healthcare provider and None of the above.
2 Options in the survey included: Not being able to see friends and family in person, Not being able to engage in regular activities, Not being able to travel, Not being able to attend church/spiritual events and Not being able to attend school/classes in person.
3 Options in the survey included: Your primary care provider, Hospitals, Friends and family, Local pharmacists, Federal public health officials (e.g., CDC), State and local public health officials, Spiritual leaders/clergy, The news media (e.g., newspapers, television, radio), State elected officials, Social media, Community leaders and Federal elected officials.
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