ABSTRACT
Importance: Recent reports indicate differences in COVID-19 related care and outcomes between Black and White Americans.Objective: We examine the COVID-19 related healthcare utilization and mortality by race and ethnicity of patients tested for SARS-CoV-2 in the Veterans Health Administration (VHA).Design: A retrospective cohort study.Setting: We used the VHA COVID-19 shared data resources between February 1 and June 30, 2020.Participants: Veterans tested for SARS-CoV-2 virus by VHA.Exposure(s): Three racial-ethnicity groups of Black, Hispanic, and White (as reference).Main Outcome(s) and Measure(s): Main outcomes are testing rate, positivity rate, hospitalization rate, ICU admission rate, and in-hospital mortality. Controlling for sex, age and Elixhauser comorbidity index, we report adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) from logistic regression models.Results: Of 8,667,996 active veteran enrollees, 252,702 were tested by VHA from February to June, 2020, with 20,500 positive results and 4,790 hospitalizations. The testing rate was 4.4% among Black and 4.7% among Hispanic veterans compared to White veterans, 2.8%. The testing positivity rate was similarly elevated among Black and Hispanic veterans compared to White veterans. The aORs of hospitalization in Black veterans (1.88; 95% CI 1.74, 2.03) and Hispanic veterans (1.41; 95% CI 1.25, 1.60) were higher compared to White veterans. No significant differences by race and ethnicity were observed in OR or aOR of ICU admission and in-hospital death among hospitalized patients.Conclusions and Relevance: On a national level, the VHA was more likely to test and hospitalize Black and Hispanic veterans compared to White veterans, but there were no significant differences in ICU admission or in-hospital mortality among those hospitalized. This pattern of differences may relate to social determinants of health, implicit biases, or preferences for VHA care affecting initial care seeking, but not in-hospital outcomes.Funding Statement: The study is funded by seed funding from Baylor College of Medicine,Houston, Texas, United States, and the Center for Innovations in Quality, Effectiveness and Safety (VA HSRD CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, Texas, United States. Declaration of Interests: None to declareEthics Approval Statement: The study was approved by the institutional review board (IRB) of Baylor College of Medicine and the Research and Development Committee of the Michael E. DeBakey VA Medical Center.