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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.
BMJ Open. 2020 08 11; 10(8):e039849.BO

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.

Authors+Show Affiliations

Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA fvahidy@houstonmethodist.org. Houston Methodist Neurological Institute, Houston, Texas, USA.Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA. Weill Cornell Medicine, New York, New York, USA. Department of Surgery, Houston Methodist Hospital, Houston, TX, United States.Weill Cornell Medicine, New York, New York, USA. Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, TX, United States.Weill Cornell Medicine, New York, New York, USA. Houston Methodist Research Institute, Houston, Texas, USA. Houston Methodist Academic Institute, Houston, TX, United States.Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA. Weill Cornell Medicine, New York, New York, USA. Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States.Weill Cornell Medicine, New York, New York, USA. Department of Medicine, Houston Methodist Hospital, Houston, TX, United States.Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA. Weill Cornell Medicine, New York, New York, USA. Texas A&M University School of Rural Public Health, College Station, Texas, USA.Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA. Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32784264

Citation

Vahidy, Farhaan S., et al. "Racial and Ethnic Disparities in SARS-CoV-2 Pandemic: Analysis of a COVID-19 Observational Registry for a Diverse US Metropolitan Population." BMJ Open, vol. 10, no. 8, 2020, pp. e039849.
Vahidy FS, Nicolas JC, Meeks JR, et al. Racial and ethnic disparities in SARS-CoV-2 pandemic: analysis of a COVID-19 observational registry for a diverse US metropolitan population. BMJ Open. 2020;10(8):e039849.
Vahidy, F. S., Nicolas, J. C., Meeks, J. R., Khan, O., Pan, A., Jones, S. L., Masud, F., Sostman, H. D., Phillips, R., Andrieni, J. D., Kash, B. A., & Nasir, K. (2020). Racial and ethnic disparities in SARS-CoV-2 pandemic: analysis of a COVID-19 observational registry for a diverse US metropolitan population. BMJ Open, 10(8), e039849. https://doi.org/10.1136/bmjopen-2020-039849
Vahidy FS, et al. Racial and Ethnic Disparities in SARS-CoV-2 Pandemic: Analysis of a COVID-19 Observational Registry for a Diverse US Metropolitan Population. BMJ Open. 2020 08 11;10(8):e039849. PubMed PMID: 32784264.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial and ethnic disparities in SARS-CoV-2 pandemic: analysis of a COVID-19 observational registry for a diverse US metropolitan population. AU - Vahidy,Farhaan S, AU - Nicolas,Juan Carlos, AU - Meeks,Jennifer R, AU - Khan,Osman, AU - Pan,Alan, AU - Jones,Stephen L, AU - Masud,Faisal, AU - Sostman,H Dirk, AU - Phillips,Robert, AU - Andrieni,Julia D, AU - Kash,Bita A, AU - Nasir,Khurram, Y1 - 2020/08/11/ PY - 2020/8/14/entrez PY - 2020/8/14/pubmed PY - 2020/9/9/medline KW - epidemiology KW - infectious diseases KW - public health SP - e039849 EP - e039849 JF - BMJ open JO - BMJ Open VL - 10 IS - 8 N2 - 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. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/32784264/Racial_and_ethnic_disparities_in_SARS_CoV_2_pandemic:_analysis_of_a_COVID_19_observational_registry_for_a_diverse_US_metropolitan_population_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=32784264 DB - PRIME DP - Unbound Medicine ER -