Mechanisms of socioeconomic differences in COVID-19 screening and hospitalizations.
PLoS One
; 16(8): e0255343, 2021.
Article
in English
| MEDLINE | ID: covidwho-1344153
ABSTRACT
BACKGROUND:
Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood.OBJECTIVE:
To characterize socioeconomic and chronic disease-related mechanisms underlying these differences.DESIGN:
Observational cohort study.SETTING:
Outpatient and emergency care. PATIENTS 12900 Cleveland Clinic Health System patients referred for SARS-CoV-2 testing between March 17 and April 15, 2020.INTERVENTIONS:
Nasopharyngeal PCR test for SARS-CoV-2 infection. MEASUREMENTS Test location (emergency department, ED, vs. outpatient care), COVID-19 symptoms, test positivity and hospitalization among positive cases.RESULTS:
We identified six classes of symptoms, ranging in test positivity from 3.4% to 23%. Non-Hispanic Black race/ethnicity was disproportionately represented in the group with highest positivity rates. Non-Hispanic Black patients ranged from 1.81 [95% confidence interval 0.91-3.59] times (at age 20) to 2.37 [1.54-3.65] times (at age 80) more likely to test positive for the SARS-CoV-2 virus than non-Hispanic White patients, while test positivity was not significantly different across the neighborhood income spectrum. Testing in the emergency department (OR 5.4 [3.9, 7.5]) and cardiovascular disease (OR 2.5 [1.7, 3.8]) were related to increased risk of hospitalization among the 1247 patients who tested positive.LIMITATIONS:
Constraints on availability of test kits forced providers to selectively test for SARS-Cov-2.CONCLUSION:
Non-Hispanic Black patients and patients from low-income neighborhoods tended toward more severe and prolonged symptom profiles and increased comorbidity burden. These factors were associated with higher rates of testing in the ED. Non-Hispanic Black patients also had higher test positivity rates.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Socioeconomic Factors
/
COVID-19 Testing
/
COVID-19
Type of study:
Cohort study
/
Diagnostic study
/
Observational study
/
Prognostic study
/
Qualitative research
/
Randomized controlled trials
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
North America
Language:
English
Journal:
PLoS One
Journal subject:
Science
/
Medicine
Year:
2021
Document Type:
Article
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