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Racial and Ethnic Disparities in Hospital Admissions from COVID-19: Determining the Impact of Neighborhood Deprivation and Primary Language.
Ingraham, Nicholas E; Purcell, Laura N; Karam, Basil S; Dudley, R Adams; Usher, Michael G; Warlick, Christopher A; Allen, Michele L; Melton, Genevieve B; Charles, Anthony; Tignanelli, Christopher J.
  • Ingraham NE; Department of Medicine, Division of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN, USA. ingra107@umn.edu.
  • Purcell LN; Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
  • Karam BS; Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
  • Dudley RA; Department of Medicine, Division of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN, USA.
  • Usher MG; Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA.
  • Warlick CA; Department of Urology, University of Minnesota, Minneapolis, MN, USA.
  • Allen ML; Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA.
  • Melton GB; Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA.
  • Charles A; Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
  • Tignanelli CJ; Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
J Gen Intern Med ; 36(11): 3462-3470, 2021 11.
Article in English | MEDLINE | ID: covidwho-1231931
ABSTRACT

BACKGROUND:

Despite past and ongoing efforts to achieve health equity in the USA, racial and ethnic disparities persist and appear to be exacerbated by COVID-19.

OBJECTIVE:

Evaluate neighborhood-level deprivation and English language proficiency effect on disproportionate outcomes seen in racial and ethnic minorities diagnosed with COVID-19.

DESIGN:

Retrospective cohort study

SETTING:

Health records of 12 Midwest hospitals and 60 clinics in Minnesota between March 4, 2020, and August 19, 2020 PATIENTS Polymerase chain reaction-positive COVID-19 patients EXPOSURES Area Deprivation Index (ADI) and primary language MAIN

MEASURES:

The primary outcome was COVID-19 severity, using hospitalization within 45 days of diagnosis as a marker of severity. Logistic and competing-risk regression models assessed the effects of neighborhood-level deprivation (using the ADI) and primary language. Within race, effects of ADI and primary language were measured using logistic regression.

RESULTS:

A total of 5577 individuals infected with SARS-CoV-2 were included; 866 (n = 15.5%) were hospitalized within 45 days of diagnosis. Hospitalized patients were older (60.9 vs. 40.4 years, p < 0.001) and more likely to be male (n = 425 [49.1%] vs. 2049 [43.5%], p = 0.002). Of those requiring hospitalization, 43.9% (n = 381), 19.9% (n = 172), 18.6% (n = 161), and 11.8% (n = 102) were White, Black, Asian, and Hispanic, respectively. Independent of ADI, minority race/ethnicity was associated with COVID-19 severity Hispanic patients (OR 3.8, 95% CI 2.72-5.30), Asians (OR 2.39, 95% CI 1.74-3.29), and Blacks (OR 1.50, 95% CI 1.15-1.94). ADI was not associated with hospitalization. Non-English-speaking (OR 1.91, 95% CI 1.51-2.43) significantly increased odds of hospital admission across and within minority groups.

CONCLUSIONS:

Minority populations have increased odds of severe COVID-19 independent of neighborhood deprivation, a commonly suspected driver of disparate outcomes. Non-English-speaking accounts for differences across and within minority populations. These results support the ongoing need to determine the mechanisms that contribute to disparities during COVID-19 while also highlighting the underappreciated role primary language plays in COVID-19 severity among minority groups.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Ethnicity / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Male Language: English Journal: J Gen Intern Med Journal subject: Internal Medicine Year: 2021 Document Type: Article Affiliation country: S11606-021-06790-w

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Ethnicity / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Male Language: English Journal: J Gen Intern Med Journal subject: Internal Medicine Year: 2021 Document Type: Article Affiliation country: S11606-021-06790-w