1. Black, Hispanic, and Asian patients had significantly higher infection rates for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to White patients.
2. Asian and Hispanic patients had greater severity of illness at admission compared to White patients.
Evidence Rating Level: 2 (Good)
Study Rundown: Coronavirus disease 2019 (COVID-19) has been reported to disproportionately affect disadvantaged, Hispanic, and Black communities in the United States. While it is largely thought that the disparity is attributed to persons living in more crowded conditions and have a higher number of comorbidities, no comprehensive quantitative analyses between ethnicity and infection rates have been conducted. This study found that race was the strongest predictor of infection with SARS-CoV-2. Furthermore, hospitalization was more frequent among Hispanic, Black, and Asian persons despite White patients being older and having a greater comorbidity burden. This study was limited by potential sampling biases associated with the rapid changes in infection control, testing, and treatment guidelines that defined the beginning of the pandemic. Nonetheless, these findings reinforce the necessity of culturally appropriate community interventions to reduce the spread of SARS-CoV-2.
Relevant Reading: Racial and Ethnic Health Disparities Related to COVID-19
In-Depth [retrospective cohort]: This study included 3,481,716 patients who were members of the Kaiser Foundation Health Plan on 1 February 2020, and either remained enrolled until 31 May 2020 or died in the same period. Collected information included self-reported race/ethnicity, several comorbidities, and severity of illness scores. White patients had the lowest incidence of infection of any group (55.1 per 100,000 persons) whereas Asian, Black, and Hispanic patients all had significantly greater incidences (111.7, 123.1, and 219.6 per 100,000, respectively). These differences were undiminished in multivariate analyses, with race accounting for 80.3% of model explanatory power with regard to infection. The highest adjusted odds ratios (aORs) for infection rates were found among Hispanic patients (aOR, 3.93; 95% confidence interval [CI], 3.59 to 4.30) and Asian patients (aOR, 2.19; 95% CI, 1.98 to 2.42). The severity of illness on admission was highest in Asian persons (12.6 points) followed by Hispanic patients (6.7 points) compared to White patients. Overall, race was shown to be the most important predictor for SARS-CoV-2 infection.
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