Abstract IA20: Potential insights into COVID-19 disparities from the science of cancer health disparities
Authors: Carethers John M. 
Published: December 2020

Abstract
Older age as well as health comorbidities that include metabolic syndrome, cardiovascular disease, hypertension, asthma, and chronic kidney disease are listed by the Centers for Diseases Control and Prevention (CDC) as strong risk factors for severe disease and mortality from COVID-19. Since the outbreak began throughout the world and the United States, both gender and race/ethnicity have additionally become associated with infection and severe COVID-10 disease and mortality. While all humans lacked immunity at its onset to the new SARS-CoV-2 virus, the cause of COVID-19, older-age individuals are likely more susceptible due to age-weakened immune systems, the presence of health comorbidities, and are the most likely group to be housed within skilled nursing facilities (SNFs) where outbreaks and death from COVID-19 have been frequent. SNFs often lacked isolation protocols, initial viral testing, and lacked personalized protection equipment (PPE) that was prioritized to hospitals. People with health comorbidities regardless of age are more susceptible to severe COVID-19 likely because of weakened health and immunity. Indeed, patients on immunosuppression for medical conditions were among the first susceptible to severe infection when the outbreak began. The association of severe COVID-19 and race/ethnicity shows the strongest rationale with socioeconomic inequalities. Those from minority-population backgrounds are often in more urban crowded areas where mitigating factors of social distancing and opportunities to avoid virus exposure are less realized. Many minority populations, as a result of socioeconomic inequality, have more difficult access to health care, hold lower-paying jobs, reside in lower-income neighborhoods with grocery store deserts, have higher use of tobacco and alcohol and demonstrate lower physical activity, and have lower use of preventive medicine. This in turn has the physiologic consequences of alteration of the gut microbiome, increased localized inflammation, and compromised immunity, leading to higher frequencies of health comorbidities, the exact conditions that have been shown to place an individual at much higher risk for mortality from COVID-19. Other COVID-19 risk factors such as blood group type A and the use of angiotensin-converting enzyme (ACE) inhibitors for the high prevalence of essential hypertension and cardiovascular disease in racial populations appear not to play a role. Specific spike protein variants that have proved to be more virulent have not been evaluated among racial groups. The use of hydroxychloroquine might play a role in sudden death if used for treatment or prophylaxis of COVID-19 in some African Americans because of the common presence of a cardiac sodium channel polymorphism. The higher risk for men over women for severe COVID-19 disease is intriguing; the SARS-CoV-2 virus requires the use of cell ACE2 receptors and the cell serine protease TMPRSS2, both regulated by androgens for expression. Differences in expression levels as well as trials of antiandrogen therapy are both being explored to assess if these permissive cell factors are the cause for gender differences.
Citation Format: John M. Carethers. Potential insights into COVID-19 disparities from the science of cancer health disparities [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr IA20.