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Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study.
Rentsch, Christopher T; Kidwai-Khan, Farah; Tate, Janet P; Park, Lesley S; King, Joseph T; Skanderson, Melissa; Hauser, Ronald G; Schultze, Anna; Jarvis, Christopher I; Holodniy, Mark; Lo Re, Vincent; Akgün, Kathleen M; Crothers, Kristina; Taddei, Tamar H; Freiberg, Matthew S; Justice, Amy C.
  • Rentsch CT; VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.
  • Kidwai-Khan F; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
  • Tate JP; VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.
  • Park LS; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
  • King JT; VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.
  • Skanderson M; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
  • Hauser RG; Stanford Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, United States of America.
  • Schultze A; VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.
  • Jarvis CI; Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States of America.
  • Holodniy M; VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.
  • Lo Re V; VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.
  • Akgün KM; Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
  • Crothers K; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
  • Taddei TH; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
  • Freiberg MS; VA Palo Alto Health Care System, US Department of Veterans Affairs, Palo Alto, California, United States of America.
  • Justice AC; Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America.
PLoS Med ; 17(9): e1003379, 2020 09.
Article in English | MEDLINE | ID: covidwho-796633
ABSTRACT

BACKGROUND:

There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVID-19 testing (i.e., who received testing and who tested positive) and subsequent mortality in the largest integrated healthcare system in the United States. METHODS AND

FINDINGS:

This retrospective cohort study included 5,834,543 individuals receiving care in the US Department of Veterans Affairs; most (91%) were men, 74% were non-Hispanic White (White), 19% were non-Hispanic Black (Black), and 7% were Hispanic. We evaluated associations between race/ethnicity and receipt of COVID-19 testing, a positive test result, and 30-day mortality, with multivariable adjustment for a wide range of demographic and clinical characteristics including comorbid conditions, health behaviors, medication history, site of care, and urban versus rural residence. Between February 8 and July 22, 2020, 254,595 individuals were tested for COVID-19, of whom 16,317 tested positive and 1,057 died. Black individuals were more likely to be tested (rate per 1,000 individuals 60.0, 95% CI 59.6-60.5) than Hispanic (52.7, 95% CI 52.1-53.4) and White individuals (38.6, 95% CI 38.4-38.7). While individuals from minority backgrounds were more likely to test positive (Black versus White odds ratio [OR] 1.93, 95% CI 1.85-2.01, p < 0.001; Hispanic versus White OR 1.84, 95% CI 1.74-1.94, p < 0.001), 30-day mortality did not differ by race/ethnicity (Black versus White OR 0.97, 95% CI 0.80-1.17, p = 0.74; Hispanic versus White OR 0.99, 95% CI 0.73-1.34, p = 0.94). The disparity between Black and White individuals in testing positive for COVID-19 was stronger in the Midwest (OR 2.66, 95% CI 2.41-2.95, p < 0.001) than the West (OR 1.24, 95% CI 1.11-1.39, p < 0.001). The disparity in testing positive for COVID-19 between Hispanic and White individuals was consistent across region, calendar time, and outbreak pattern. Study limitations include underrepresentation of women and a lack of detailed information on social determinants of health.

CONCLUSIONS:

In this nationwide study, we found that Black and Hispanic individuals are experiencing an excess burden of SARS-CoV-2 infection not entirely explained by underlying medical conditions or where they live or receive care. There is an urgent need to proactively tailor strategies to contain and prevent further outbreaks in racial and ethnic minority communities.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Veterans / Coronavirus Infections / Clinical Laboratory Techniques Type of study: Diagnostic study / Etiology study / Incidence study / Observational study / Risk factors Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: North America Language: English Journal: PLoS Med Journal subject: Medicine Year: 2020 Document Type: Article Affiliation country: Journal.pmed.1003379

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Veterans / Coronavirus Infections / Clinical Laboratory Techniques Type of study: Diagnostic study / Etiology study / Incidence study / Observational study / Risk factors Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: North America Language: English Journal: PLoS Med Journal subject: Medicine Year: 2020 Document Type: Article Affiliation country: Journal.pmed.1003379