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Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study.
PLoS Med. 2020 09; 17(9):e1003379.PM

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.

Authors+Show Affiliations

VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America. Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.Stanford Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, United States of America.VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America. Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States of America.VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America. Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.VA Palo Alto Health Care System, US Department of Veterans Affairs, Palo Alto, California, United States of America. Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America.Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington, United States of America. Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America.VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, Tennessee, United States of America. Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America. Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32960880

Citation

Rentsch, Christopher T., et al. "Patterns of COVID-19 Testing and Mortality By Race and Ethnicity Among United States Veterans: a Nationwide Cohort Study." PLoS Medicine, vol. 17, no. 9, 2020, pp. e1003379.
Rentsch CT, Kidwai-Khan F, Tate JP, et al. Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study. PLoS Med. 2020;17(9):e1003379.
Rentsch, C. T., Kidwai-Khan, F., Tate, J. P., Park, L. S., King, J. T., Skanderson, M., Hauser, R. G., Schultze, A., Jarvis, C. I., Holodniy, M., Lo Re, V., Akgün, K. M., Crothers, K., Taddei, T. H., Freiberg, M. S., & Justice, A. C. (2020). Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study. PLoS Medicine, 17(9), e1003379. https://doi.org/10.1371/journal.pmed.1003379
Rentsch CT, et al. Patterns of COVID-19 Testing and Mortality By Race and Ethnicity Among United States Veterans: a Nationwide Cohort Study. PLoS Med. 2020;17(9):e1003379. PubMed PMID: 32960880.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study. AU - Rentsch,Christopher T, AU - Kidwai-Khan,Farah, AU - Tate,Janet P, AU - Park,Lesley S, AU - King,Joseph T,Jr AU - Skanderson,Melissa, AU - Hauser,Ronald G, AU - Schultze,Anna, AU - Jarvis,Christopher I, AU - Holodniy,Mark, AU - Lo Re,Vincent,3rd AU - Akgün,Kathleen M, AU - Crothers,Kristina, AU - Taddei,Tamar H, AU - Freiberg,Matthew S, AU - Justice,Amy C, Y1 - 2020/09/22/ PY - 2020/06/11/received PY - 2020/08/31/accepted PY - 2020/9/22/entrez PY - 2020/9/23/pubmed PY - 2020/10/2/medline SP - e1003379 EP - e1003379 JF - PLoS medicine JO - PLoS Med VL - 17 IS - 9 N2 - 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. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/32960880/Patterns_of_COVID_19_testing_and_mortality_by_race_and_ethnicity_among_United_States_veterans:_A_nationwide_cohort_study_ L2 - https://dx.plos.org/10.1371/journal.pmed.1003379 DB - PRIME DP - Unbound Medicine ER -