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Covid-19 by Race and Ethnicity: A National Cohort Study of 6 Million United States Veterans (preprint)
medrxiv; 2020.
Preprint Dans Anglais | medRxiv | ID: ppzbmed-10.1101.2020.05.12.20099135
ABSTRACT

Background:

There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of morbidity and mortality from symptomatic SARS-Cov-2 infection or coronavirus disease 2019 (Covid-19). Most studies investigating racial and ethnic disparities to date have focused on hospitalized patients or have not characterized who received testing or those who tested positive for Covid-19.

Objective:

To compare patterns of testing and test results for coronavirus 2019 (Covid-19) and subsequent mortality by race and ethnicity in the largest integrated healthcare system in the United States.

Design:

Retrospective cohort study.

Setting:

United States Department of Veterans Affairs (VA).

Participants:

5,834,543 individuals in care, among whom 62,098 were tested and 5,630 tested positive for Covid-19 between February 8 and May 4, 2020. Exposures Self-reported race/ethnicity. Main outcome

measures:

We evaluated associations between race/ethnicity and receipt of Covid-19 testing, a positive test result, and 30-day mortality, accounting for a wide range of demographic and clinical risk factors including comorbid conditions, site of care, and urban versus rural residence.

Results:

Among all individuals in care, 74% were non-Hispanic white (white), 19% non-Hispanic black (black), and 7% Hispanic. Compared with white individuals, black and Hispanic individuals were more likely to be tested for Covid-19 (tests per 1000 white=9.0, [95% CI 8.9 to 9.1]; black=16.4, [16.2 to 16.7]; and Hispanic=12.2, [11.9 to 12.5]). While individuals from minority backgrounds were more likely to test positive (black vs white OR 1.96, 95% CI 1.81 to 2.12; Hispanic vs white OR 1.73, 95% CI 1.53 to 1.96), 30-day mortality did not differ by race/ethnicity (black vs white OR 0.93, 95% CI 0.64 to 1.33; Hispanic vs white OR 1.07, 95% CI 0.61 to 1.87).

Conclusions:

Black and Hispanic individuals are experiencing an excess burden of Covid-19 not entirely explained by underlying medical conditions or where they live or receive care. While there was no observed difference in mortality by race or ethnicity, our findings may underestimate risk in the broader US population as health disparities tend to be reduced in VA.
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Texte intégral: Disponible Collection: Preprints Base de données: medRxiv Sujet Principal: langue: Anglais Année: 2020 Type de document: Preprint

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Texte intégral: Disponible Collection: Preprints Base de données: medRxiv Sujet Principal: langue: Anglais Année: 2020 Type de document: Preprint