Underlying Health Conditions And How They Impact Our Vulnerability in Hawaii
This is part of a series of posts highlighting results from the Hawaii COVID Contact Tracking Survey conducted by the National Disaster Preparedness Training Center (NDPTC) and the Pacific Urban Resilience Lab (PURL) at the University of Hawaii at Manoa. The Hawaii Data Collaborative has partnered with this group to share regular analyses and updates from this survey in the coming weeks. If you have not done so already, we encourage you to participate in the survey here.
While Hawaii seems to have stemmed the spread of the Coronavirus for the time being, health experts and our community leaders continue to express undertones of caution. That applies especially to our kupuna and anyone who may have serious underlying medical conditions.
According to the Centers for Disease Control and Prevention (CDC), individuals at high risk for severe illness from COVID-19 are people:
65 years and older,
Who live in a nursing home or long-term care facility,
Of all ages with underlying medical conditions, particularly if not well controlled.
Those underlying medical conditions include those:
With chronic lung disease or moderate to severe asthma,
Who have serious heart conditions,
Who are immunocompromised,
Conditions that can cause one to be immunocompromised include: cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications.
With severe obesity (body mass index [BMI] of 40 or higher),
With diabetes,
With chronic kidney disease undergoing dialysis,
With liver disease.
Hawaii is ranked as one of the healthiest states in the nation and, in one measure, is the healthiest in the nation for the third year in a row, according to the United Health Foundation in its America’s Health Rankings. United Health is a not-for-profit, private foundation focused on health and healthcare. But that seal of approval does not apply to all of us uniformly, nor are we without pockets of serious health concern.
For example, the leading cause of death in the islands is heart disease followed by cancer, stroke and flu/pneumonia, according to the CDC’s National Center for Health Statistics. In fact, Hawaii is ranked first in the nation for deaths caused by flu or pneumonia. When viewed through the lens of ethnicity (Hawaii is one of only four states in which non-Hispanic whites do not make up the majority of the population), those of Asian, Filipinos, Native Hawaiians, and other Pacific Islanders all have specific health issues relating to chronic diseases.
The state’s median age is slightly older than the national median age (39.2 in 2018 compared to 38.2 for the nation, US Census Bureau 2018 Population Estimates) and we have a larger percentage of seniors compared to the rest of the nation (18.4% vs. 16.0% in the US; 2018 American Community Survey 1-Year Estimates), which influence both our underlying medical conditions and our vulnerability to the Coronavirus.
What do data collected from our own surveys tell us about our underlying medical conditions and where we are most vulnerable during this pandemic?
The good news is that our data show that social distancing does reduce an individual’s risk of exposure to COVID-19. This is particularly important for older adults who are more likely to have chronic illnesses[1] and experience severe negative consequences as a result of contracting COVID-19. The chart is a positive sign that individuals in the state who are more vulnerable are also less exposed to the virus.
While working-age individuals are the least likely to social distance, younger and older individuals are more likely to do so. Based on our survey, the risk of exposure to COVID-19 decreases with age, because of the ability of older adults to maintain complete social distancing. It is not clear why risk of exposure for younger individuals does not decrease in like manner. This may be one area for further investigation (one theory is that younger adults are more likely to live with more household members who may increase the risk of exposure).
By Ethnicity
Our data show that Native Americans, Native Hawaiians and African Americans had the highest number of respondents with chronic health issues. However, of the three, Native Hawaiians make up the largest percentage of the state’s total population.
All ethnicities, except Native American, were relatively disciplined in terms of social distancing in relationship to exposure risk. Native American respondents had the highest percentage with a chronic illness and second highest risk of exposure. This is a possible area of concern for a group that may lack the proper support to avoid contracting the virus.
Asian respondents had the second lowest percentage of respondents with a chronic illness and the lowest risk of exposure. Relative to other groups, there is less concern for this group (the case is similar for Caucasians). Pacific Islander respondents were the most disciplined in their social distancing practices relative to their exposure risk.
By Community
Respondents from Waianae had the highest percentage with chronic illness, but also had the second lowest exposure risk. The greatest exposure risk was found in the communities of Molokai and Lanai which, by contrast, had higher percentages reporting exposure to COVID-19 and a considerable proportion of respondents with a chronic illness.
All communities, except Molokai, Lanai, and Windward Oahu, were disciplined in social distancing relative to their reported risk of exposure.
Although the number of respondents from Molokai and Lanai was relatively small, this is an area of concern given that these are small rural communities. It is also somewhat surprising that these more isolated communities have such a high percentage of respondents reporting that they have been exposed to COVID-19. This could be the result of self-selection bias, but if so, is suggestive of a community’s consternation.
By Occupation
When looking at the data by occupation, retired respondents were the “safest” compared to individuals in other occupations (including unemployed and student). Good news when considering their high level of chronic health issues.
Student respondents had the lowest percentage of individuals with a chronic illness, but their reported exposure risk was the third highest. Local student respondents were also relatively disciplined in terms of social distancing (i.e., they had the greatest percentage of social distancers). This is somewhat surprising given the stereotypical image of the carefree student that many have (self-selection bias may be playing a role here given the survey’s origin).
Respondents in the military were among the least likely to do social distancing, but had the lowest risk of exposure compared with respondents of other occupations.
Respondents in medical and manufacturing occupations had the greatest risk of contracting COVID-19. These occupations are in direct contrast with the retired and unemployed respondents, who had relatively high rates of chronic illness, but lower risk of exposure and greater social distancing. Because of their high risk of exposure, respondents in medical and manufacturing occupations represent an area of concern.
Finally, we believe the survey clarifies and better defines the notion of “vulnerability” as it relates to the Coronavirus and the pandemic that we all currently face. Seniors and others with chronic underlying health conditions—whether it’s heart disease or diabetes—are vulnerable in terms of their ability to withstand the onslaught of the disease itself. They, as well as others, may also be “vulnerable” because of their occupation, living condition, or ability to practice social distancing.
Understanding these two primary ways that makes us more vulnerable—and more importantly, how they intersect—will help us better navigate the current pandemic and prepare us for future outbreaks.
The results of our survey are encouraging, with the majority of communities, ethnicities, and vulnerable people social distancing at rates greater than their respective exposure risk. This has likely played a critical role in the state’s ability to stem the spread of the virus and speaks again to our overarching culture of caring for one another.
Related Posts in this Series
Insights From the Hawaii COVID Contact Tracking Survey
The Good, The Bad, and Social Distancing in Hawaii
Ongoing and Comprehensive Information Key to Reopening Hawaii
Our Kupuna: Understanding Their Risks
Contact Tracing versus Contact Tracking
How Vulnerable is Hawaii in the Face of a Coronavirus Pandemic?
Small Business May Play A Not-So-Small Part In Restarting Hawaii's Economy
Family Ties: Are Hawaii’s Multigenerational Families More at Risk?
