Differences in COVID-19 Related Testing and Healthcare Utilization by Race and Ethnicity in the Veterans Health Administration (preprint)

ABSTRACT

Importance Recent reports indicate differences in COVID-19 related care and outcomes between Black and White Americans.Objective: We examine the COVID-19 related healthcare utilization and mortality by race and ethnicity of patients tested for SARS-CoV-2 in the Veterans Health Administration (VHA).Design: A retrospective cohort study.Setting: We used the VHA COVID-19 shared data resources between February 1 and June 30, 2020.Participants: Veterans tested for SARS-CoV-2 virus by VHA.Exposure(s) Three racial-ethnicity groups of Black, Hispanic, and White (as reference).Main Outcome(s) and Measure(s) Main outcomes are testing rate, positivity rate, hospitalization rate, ICU admission rate, and in-hospital mortality. Controlling for sex, age and Elixhauser comorbidity index, we report adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) from logistic regression models.Results: Of 8,667,996 active veteran enrollees, 252,702 were tested by VHA from February to June, 2020, with 20,500 positive results and 4,790 hospitalizations. The testing rate was 4.4% among Black and 4.7% among Hispanic veterans compared to White veterans, 2.8%. The testing positivity rate was similarly elevated among Black and Hispanic veterans compared to White veterans. The aORs of hospitalization in Black veterans (1.88; 95% CI 1.74, 2.03) and Hispanic veterans (1.41; 95% CI 1.25, 1.60) were higher compared to White veterans. No significant differences by race and ethnicity were observed in OR or aOR of ICU admission and in-hospital death among hospitalized patients.Conclusions and Relevance On a national level, the VHA was more likely to test and hospitalize Black and Hispanic veterans compared to White veterans, but there were no significant differences in ICU admission or in-hospital mortality among those hospitalized. This pattern of differences may relate to social determinants of health, implicit biases, or preferences for VHA care affecting initial care seeking, but not in-hospital outcomes.Funding Statement The study is funded by seed funding from Baylor College of Medicine,Houston, Texas, United States, and the Center for Innovations in Quality, Effectiveness and Safety (VA HSRD CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, Texas, United States. Declaration of Interests None to declareEthics Approval Statement The study was approved by the institutional review board (IRB) of Baylor College of Medicine and the Research and Development Committee of the Michael E. DeBakey VA Medical Center.