Racial/ethnic and neighbourhood social vulnerability disparities in COVID-19 testing positivity, hospitalization, and in-hospital mortality in a large hospital system in Pennsylvania: A prospective study of electronic health records.

Background: Disparities in COVID-19 mortality by race/ethnicity or neighborhood have been documented using surveillance data. We aimed to describe disparities by race/ethnicity and neighbourhood social vulnerability in COVID-19 positivity, hospitalization, and mortality. Methods: We obtained data from the electronic health records of all individuals who tested positive for COVID-19 in the University of Pennsylvania Health System (UPHS) or were hospitalized with confirmed COVID-19 infection in five UPHS hospitals from March 1, 2020, to March 31, 2021. The main predictors were race/ethnicity and neighbourhood-level social vulnerability. The main outcomes were COVID-19 test positivity, hospitalization with COVID-19, and 30-day in-hospital mortality following hospitalization with COVID-19. Findings: A total of 225,129 unique individuals received COVID-19 testing and 18,995 had a positive test result. A total of 5,794 unique patients were hospitalized with COVID-19 and 511 died in-hospital within 30 days. Racial/ethnic minority groups and residents of higher social vulnerability neighbourhoods had higher test positivity and risk of hospitalization. We did not see in-hospital mortality disparities during the first wave but observed 75% and 68% higher odds of death among Hispanic and Asians compared to Whites during subsequent waves. Interpretation: We observed significant racial/ethnic and neighbourhood disparities in COVID-19 outcomes, especially test positivity and odds of hospitalization, highlighting the importance of equitably improving access to preventive measures to reduce SARS-CoV-2 infection, including reducing exposure to the virus and ensuring equity in vaccination. Funding: National Institutes of Health.

Understanding Drivers of Coronavirus Disease 2019 Vaccine Hesitancy Among Blacks.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has disproportionately affected communities of color, with black persons experiencing the highest rates of disease severity and mortality. A vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the potential to reduce the race mortality gap from COVID-19; however, hesitancy toward the vaccine in the black community threatens vaccine uptake. METHODS: We conducted focus groups with black barbershop and salon owners living in zip codes of elevated COVID-19 prevalence to assess their attitudes, beliefs, and norms around a COVID-19 vaccine. We used a modified grounded theory approach to analyze the transcripts. RESULTS: We completed 4 focus groups (N = 24 participants) in July and August 2020. Participants were an average age of 46 years, and 89% were black non-Hispanic. Hesitancy against the COVID-19 vaccine was high due to mistrust in the medical establishment, concerns with the accelerated timeline for vaccine development, limited data on short- and long-term side effects, and the political environment promoting racial injustice. Some participants were willing to consider the vaccine once the safety profile is robust and reassuring. Receiving a recommendation to take the vaccine from a trusted healthcare provider served as a facilitator. Health beliefs identified were similar to concerns around other vaccines and included the fear of getting the infection with vaccination and preferring to improve one's baseline physical health through alternative therapies. CONCLUSIONS: We found that hesitancy of receiving the COVID-19 vaccine was high; however, provider recommendation and transparency around the safety profile might help reduce this hesitancy.