A Disease of Rich People?

 

Is COVID-19 a disease of rich people?

I usually check the COVID-19 data explorer at ourworldindata.org once a day, sometimes just to see how COVID-19 cases and deaths are trending in the United States, and occasionally to compare with what’s going on in the European Union or with individual countries such as Ireland, India, Ukraine, or the United Kingdom. It’s easy. On the left is a check-box list. You can check the countries or regions you want to appear on the graph or uncheck them to remove them when the graph gets too cluttered. There is also a slider one can use to take a closer look at the most recent period.

Tonight, I noticed something different, three new categories that are not countries: high income, upper middle income, and lower middle income. I have no idea where those data are coming from, but I’ll wager a guess that they represent data from the United States. So here’s what they look like.

covid-19 deaths by economic status

covid-19 cases by economic statusNote that except for a period earlier this year, COVID-19 deaths and cases both occurred at a higher rate in the upper income group.

I wasn’t sure if these are real data or a practical joke, but I did an Internet search for “COVID rich person’s disease” and found this from an Los Angeles Times article very early in the pandemic:

Pandemics throughout history have been associated with the underprivileged, but in many developing countries the coronavirus was a high-class import — carried in by travelers returning from business trips in China, studies in Europe, ski vacations in the Rockies.

As infections initially concentrated in better neighborhoods, many poor and working-class people believed the disease wouldn’t touch them, as if something terrible but rarefied. The misperception was fed by elites, including the governor of Mexico’s Puebla state, Luis Miguel Barbosa, who said in March: “If you’re rich, you’re at risk, but if you’re poor, you’re not. The poor, we’re immune.”

By now it is clear that COVID-19 spares no one and disproportionately harms the hungry, the forgotten and those with preexisting illnesses and substandard healthcare.

But now, 1.5 years after that article was written, is it becoming clear that COVID-19 disproportionately harms the rich?

Some other questions come to mind:

  • Are these data real?
  • Do these trends hold for all countries and regions?
  • Does this mean that all the mandates and lockdowns were used to shut down the little people in order to protect their betters, who are more vulnerable?
  • A reversal of the trend seems to have taken place about the time vaccines were introduced and to have lasted through midsummer. Is this why rich people (including a lot of government and government-adjacent people) were so insistent about vaccines? Partial disclosure: I’m pretty enthusiastic about the vaccines myself, am extremely middle income, and have been adjacent to a lot of government-adjacent people throughout most of my working life.
  • How does this information square with information showing that severe COVID-19 is mostly a problem for the elderly and the obese?
  • A closer look will probably suggest other questions. What am I missing so far?

Note: You can click on the graphs to go to the website and compare with other data.

Published in Healthcare
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  1. Judge Mental Member
    Judge Mental
    @JudgeMental

    Old people are richer than young people?  Meaning, on average, those with co-morbidities will be richer?

    • #1
  2. The Reticulator Member
    The Reticulator
    @TheReticulator

    Judge Mental (View Comment):

    Old people are richer than young people? Meaning, on average, those with co-morbidities will be richer?

    Maybe. I guess somebody needs to do the numbers. 

    • #2
  3. The Reticulator Member
    The Reticulator
    @TheReticulator

    The Reticulator (View Comment):
    Maybe. I guess somebody needs to do the numbers.

    By which I mean: Compare old, high-income people with old, low-income people, and so on.

    • #3
  4. The Reticulator Member
    The Reticulator
    @TheReticulator

    The Reticulator (View Comment):

    The Reticulator (View Comment):
    Maybe. I guess somebody needs to do the numbers.

    By which I mean: Compare old, high-income people with old, low-income people, and so on.

    Or do a multiple, linear regression to see which factors account for how much (even though the causal relationships are probably not linear and additive).  

    • #4
  5. Doctor Robert Member
    Doctor Robert
    @DoctorRobert

    Wealth associates with longevity, obesity and inadequate physical activity.  Case closed.

    • #5
  6. DonG (CAGW is a hoax) Coolidge
    DonG (CAGW is a hoax)
    @DonG

    The Reticulator: covid-19 deaths and cases both occurred at a higher rate in the upper income group.

    There is a difference between reported incidence and actual incidence.  High income means more reporting.   There is also a correlation between latitude and air-tight work places and high income.  Less sun and indoor work are bad for Wuhan Lab Flu.  It is also the case that high-income countries are run by Big Pharma (the put their efforts where the money is). 

    • #6
  7. The Reticulator Member
    The Reticulator
    @TheReticulator

    Doctor Robert (View Comment):

    Wealth associates with longevity, obesity and inadequate physical activity. Case closed.

    You just opened the case. How can we close it already? 

    • #7
  8. Saint Augustine Member
    Saint Augustine
    @SaintAugustine

    The richer the country, the more they spend on tests?

    • #8
  9. The Reticulator Member
    The Reticulator
    @TheReticulator

    Saint Augustine (View Comment):

    The richer the country, the more they spend on tests?

    Here’s where at would be nice to know if those data represent anything more than the United States. 

    • #9
  10. BDB Coolidge
    BDB
    @BDB

    All along, Ive suspected that reported rates are hignest in relatively sophisticated, relatively honest countries.  Why?  Because those too dysfunctional to conduct tests or too dishonest to report are “underrepresented”.

    As usual.

    • #10
  11. The Reticulator Member
    The Reticulator
    @TheReticulator

    BDB (View Comment):

    All along, Ive suspected that reported rates are hignest in relatively sophisticated, relatively honest countries. Why? Because those too dysfunctional to conduct tests or too dishonest to report are “underrepresented”.

    As usual.

    Most likely. But that wouldn’t apply here unless these data represent a variety of countries.  I was hoping somebody might know more about other data along these lines and could help fill in some of the gaps in our knowledge. 

    • #11
  12. BDB Coolidge
    BDB
    @BDB

    The Reticulator (View Comment):

    BDB (View Comment):

    All along, Ive suspected that reported rates are hignest in relatively sophisticated, relatively honest countries. Why? Because those too dysfunctional to conduct tests or too dishonest to report are “underrepresented”.

    As usual.

    Most likely. But that wouldn’t apply here unless these data represent a variety of countries. I was hoping somebody might know more about other data along these lines and could help fill in some of the gaps in our knowledge.

    Yep.  I’m commenting in parallel, not series.  Agreed.

    • #12
  13. Annefy Member
    Annefy
    @Annefy

    I remember reading that polio was mostly a middle-class to rich disease. That poorer people, living in close, and dirtier, quarters, had been exposed and developed immunity.

    • #13
  14. Kozak Member
    Kozak
    @Kozak

    The Reticulator (View Comment):

    Judge Mental (View Comment):

    Old people are richer than young people? Meaning, on average, those with co-morbidities will be richer?

    Maybe. I guess somebody needs to do the numbers.

    • #14
  15. Buckpasser Member
    Buckpasser
    @Buckpasser

    Doctor Robert (View Comment):

    Wealth associates with longevity, obesity and inadequate physical activity. Case closed.

    Why do the rest of us have to suffer face diapers, “vaccine papers please” and home confinement?

    • #15
  16. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    Doctor Robert (View Comment):

    Wealth associates with longevity, obesity and inadequate physical activity. Case closed.

    In my experience, that association would be inverse.

    In America, poor people tend to be overweight, inactive, and in poor health.  Rich people don’t smoke cigarettes, they watch what they eat and they do Pilates.

    I’m generalizing, of course.  But that’s been my experience.

    • #16
  17. Blondie Thatcher
    Blondie
    @Blondie

    Annefy (View Comment):

    I remember reading that polio was mostly a middle-class to rich disease. That poorer people, living in close, and dirtier, quarters, had been exposed and developed immunity.

    This was my first thought, also. I keep reading that most infections were/are caught and passed in the home. The “working class” were deemed the essential workers and didn’t stay home with the rest of the family. 

    • #17
  18. Blondie Thatcher
    Blondie
    @Blondie

    Hey, @thereticulator, this sounds like a good question to pose Doc Jay on the webcast Tuesday. I’m pretty sure I’ve heard him say the lockdowns for healthy people was a mistake, lending credence to @annefy‘s comment. 

    • #18
  19. Old Bathos Moderator
    Old Bathos
    @OldBathos

    The richest countries tend to have higher case numbers and deaths.  I attribute that to (a) better public health resources for wider testing; (b) older populations and (c) greater distance from China (less accumulated evolutionary exposure to the viral goodies originating there so less cross-immunity).

    COVID deaths in the USA appear to be more common for poorer, non-white, older people than other demographic slices. When I have looked at data from county and state sources, that is almost always the pattern. My home county is 60% white but 57% of all reported COVID cases are non-white residents.  It is not possible that the rich are infected more often here.

     

    • #19
  20. The Reticulator Member
    The Reticulator
    @TheReticulator

    Annefy (View Comment):

    I remember reading that polio was mostly a middle-class to rich disease. That poorer people, living in close, and dirtier, quarters, had been exposed and developed immunity.

    I’ve heard something similar, but don’t remember ever seeing what kind of data it’s based on, so have no idea how strong the relationship was between the disease and socio-economic class. 

    • #20
  21. Ekosj Member
    Ekosj
    @Ekosj

    I think the data are global…not just for the US.  And they are just putting countries into high/medium/low income buckets and aggregating.    That certainly seems to be how they are doing a similar graph on cases not mortality.

    Being global, high income correlates to lots of testing.   So the key word in the presentation is “Confirmed.”

    Also, health care is better in high income countries.    So in a high income country, the comorbidity that contributes to a death from Covid might, in a low income country, be fatal long before you got a chance to contract Covid.

    • #21
  22. MarciN Member
    MarciN
    @MarciN

    Doctor Robert (View Comment):
    obesity and inadequate physical activity

    Sometimes I think we incorrectly equate obesity with a sedentary lifestyle. 

    For pneumonia, the sedentary lifestyle would be the dominant lifestyle problem, and that cuts across all heights and weights for various reasons. A four-hundred-pound football player will be less likely to die from pneumonia than a 90-pound woman who lives alone in her tiny apartment and can’t get out for walks and can’t afford a gym and spends her time watching television or reading. 

     

    • #22
  23. Gumby Mark (R-Meth Lab of Democracy) Thatcher
    Gumby Mark (R-Meth Lab of Democracy)
    @GumbyMark

    Two factors to keep in mind.

    The chart you are using includes only officially reported data and we have good evidence that there are many countries where covid deaths are on the low side due to deliberate misreporting or to weak public health reporting systems (today’s WSJ carried a lengthy article on these issues in sub-Saharan Africa), which tend to be middle or low income countries.

    We would also need to see the chart adjusted for age related mortality.  Many low-income countries have a much younger average population than high-income countries.  Since the overwhelming risk factor with covid is age, even more than obesity or other health conditions, this can skew the data.

    The age factor can even be seen in the U.S. data.  Utah has the youngest average age of any state.  Its official covid infection rate is 7th in the country but its mortality rate is 46th.

    • #23
  24. Old Bathos Moderator
    Old Bathos
    @OldBathos

    MarciN (View Comment):
    Sometimes I think we incorrectly equate obesity with a sedentary lifestyle. 

    My active pursuit of excess calories is anything but sedentary.  It takes discipline not to take two pieces of cake over to the coffee table to watch TV–only one at a time so to get in those extra steps back and forth to score that second slice.

    • #24
  25. cdor Member
    cdor
    @cdor

    Are rich people generally healthier than poor people? Have they been able to afford better health care throughout their lives? Do rich people generally live longer than poor people? I do not know these things…but maybe Mr. Google does. I will ask him.

    • #25
  26. cdor Member
    cdor
    @cdor

    OK, I asked Mr. Google and this is what he said…https://duckduckgo.com/?q=do+rich+people+live+longer&atb=v153-1&ia=web

     

    P.S.

    I don’t speak to him directly. I always have my pet duck talk for me.

    • #26
  27. Misthiocracy got drunk and Member
    Misthiocracy got drunk and
    @Misthiocracy

    a) I dunno about COVID rates now, but it’s definitely true that governments didn’t start to take COVID seriously until politicians in Europe started dying from it. There’s an argument that one of the real reasons for nationwide lockdowns is that politicians didn’t want to appear like hypocritical ninnies by only locking down the legislatures.

    b) If those statistics are for global COVID rates, then they are likely skewed by the fact that respiratory viruses in general, and COVID specifically, tend do a heck of a lot better in colder/drier climates than in hotter/humid climates. I would really like to see similar graphs for rhinoviruses and influenza. You rarely hear much about influenza epidemics in the tropics.

    • #27
  28. DrewInWisconsin, Oaf Member
    DrewInWisconsin, Oaf
    @DrewInWisconsin

    Annefy (View Comment):

    I remember reading that polio was mostly a middle-class to rich disease. That poorer people, living in close, and dirtier, quarters, had been exposed and developed immunity.

    Yeah, I’m thinking along those lines. We all expected COVID to wipe out homeless camps in California cities, . . . but it didn’t.

    • #28
  29. Misthiocracy got drunk and Member
    Misthiocracy got drunk and
    @Misthiocracy

    Annefy (View Comment):

    I remember reading that polio was mostly a middle-class to rich disease. That poorer people, living in close, and dirtier, quarters, had been exposed and developed immunity.

    Again, if the statistics are for global COVID rates, the world’s poor tend to spend a lot more time outdoors breathing relatively fresh aid while the world’s rich tend to spend more time indoors breathing recirculated air.  Epidemics in the poorer parts of the world are usually waterborne, foodborne, bloodborne, and/or insectborne.  It’s much rarer for those parts of the world to be devastated by an airborne virus, because airborne viruses do best where lots of people congregate indoors.

    We in the West tend to think of our poor being more-or-less representative of the poor in general, but our poor are incredibly privileged compared to the world’s poor.  Western poor folk are far more likely to live sedentary lives indoors than the global poor who are far more likely to toil for long hours outdoors just to survive.

    The exception, not coincidentally, is in rapidly-developing Asian countries (e.g. China, Vietnam, etc.) where a much larger proportion of the poor toil for long hours in cramped factories.  This helps explain why they have higher COVID rates even though they have hot and humid climates.

    • #29
  30. Misthiocracy got drunk and Member
    Misthiocracy got drunk and
    @Misthiocracy

    Annefy (View Comment):

    I remember reading that polio was mostly a middle-class to rich disease. That poorer people, living in close, and dirtier, quarters, had been exposed and developed immunity.

    Apropos of nothing: Polio provides a good example of a statistical quirk that can lead people to think vaccines aren’t safe.  According to the Polio Eradication Initiative, in 2019 more than twice as many people caught polio from the polio vaccine (361 cases) than did people who caught it in the wild (175 cases), but without the vaccine the total number of polio cases would be way higher than only 536 people worldwide per year.

    (Note: All those 536 cases were in “poor” countries.  The 175 wild cases were in just two countries: Pakistan and Afghanistan.)

    • #30