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Racial and ethnic disparities in SARS-CoV-2 pandemic: analysis of a COVID-19 observational registry for a diverse US metropolitan population.
Vahidy, Farhaan S; Nicolas, Juan Carlos; Meeks, Jennifer R; Khan, Osman; Pan, Alan; Jones, Stephen L; Masud, Faisal; Sostman, H Dirk; Phillips, Robert; Andrieni, Julia D; Kash, Bita A; Nasir, Khurram.
  • Vahidy FS; Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA fvahidy@houstonmethodist.org.
  • Nicolas JC; Houston Methodist Neurological Institute, Houston, Texas, USA.
  • Meeks JR; Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.
  • Khan O; Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.
  • Pan A; Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.
  • Jones SL; Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.
  • Masud F; Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.
  • Sostman HD; Weill Cornell Medicine, New York, New York, USA.
  • Phillips R; Department of Surgery, Houston Methodist Hospital, Houston, TX, United States.
  • Andrieni JD; Weill Cornell Medicine, New York, New York, USA.
  • Kash BA; Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, TX, United States.
  • Nasir K; Weill Cornell Medicine, New York, New York, USA.
BMJ Open ; 10(8): e039849, 2020 08 11.
Article in English | MEDLINE | ID: covidwho-714383
ABSTRACT

INTRODUCTION:

Data on race and ethnic disparities for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. We analysed sociodemographic factors associated with higher likelihood of SARS-CoV-2 infection and explore mediating pathways for race and ethnic disparities in the SARS-CoV-2 pandemic.

METHODS:

This is a cross-sectional analysis of the COVID-19 Surveillance and Outcomes Registry, which captures data for a large healthcare system, comprising one central tertiary care hospital, seven large community hospitals and an expansive ambulatory/emergency care network in the Greater Houston area. Nasopharyngeal samples for individuals inclusive of all ages, races, ethnicities and sex were tested for SARS-CoV-2. We analysed sociodemographic (age, sex, race, ethnicity, household income, residence population density) and comorbidity (Charlson Comorbidity Index, hypertension, diabetes, obesity) factors. Multivariable logistic regression models were fitted to provide adjusted OR (aOR) and 95% CI for likelihood of a positive SARS-CoV-2 test. Structural equation modelling (SEM) framework was used to explore three mediation pathways (low income, high population density, high comorbidity burden) for the association between non-Hispanic black (NHB) race, Hispanic ethnicity and SARS-CoV-2 infection.

RESULTS:

Among 20 228 tested individuals, 1551 (7.7%) tested positive. The overall mean (SD) age was 51.1 (19.0) years, 62% were females, 22% were black and 18% were Hispanic. NHB and Hispanic ethnicity were associated with lower socioeconomic status and higher population density residence. In the fully adjusted model, NHB (vs non-Hispanic white; aOR, 2.23, CI 1.90 to 2.60) and Hispanic ethnicity (vs non-Hispanic; aOR, 1.95, CI 1.72 to 2.20) had a higher likelihood of infection. Older individuals and males were also at higher risk of infection. The SEM framework demonstrated a significant indirect effect of NHB and Hispanic ethnicity on SARS-CoV-2 infection mediated via a pathway including residence in densely populated zip code.

CONCLUSIONS:

There is strong evidence of race and ethnic disparities in the SARS-CoV-2 pandemic that are potentially mediated through unique social determinants of health.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Health Status Disparities / Pandemics / Race Factors Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: BMJ Open Year: 2020 Document Type: Article Affiliation country: Bmjopen-2020-039849

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Health Status Disparities / Pandemics / Race Factors Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: BMJ Open Year: 2020 Document Type: Article Affiliation country: Bmjopen-2020-039849