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Racial Disparities in COVID-19 Testing and Outcomes : Retrospective Cohort Study in an Integrated Health System.
Ann Intern Med. 2021 06; 174(6):786-793.AIM

Abstract

BACKGROUND

Racial disparities exist in outcomes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

OBJECTIVE

To evaluate the contribution of race/ethnicity in SARS-CoV-2 testing, infection, and outcomes.

DESIGN

Retrospective cohort study (1 February 2020 to 31 May 2020).

SETTING

Integrated health care delivery system in Northern California.

PARTICIPANTS

Adult health plan members.

MEASUREMENTS

Age, sex, neighborhood deprivation index, comorbid conditions, acute physiology indices, and race/ethnicity; SARS-CoV-2 testing and incidence of positive test results; and hospitalization, illness severity, and mortality.

RESULTS

Among 3 481 716 eligible members, 42.0% were White, 6.4% African American, 19.9% Hispanic, and 18.6% Asian; 13.0% were of other or unknown race. Of eligible members, 91 212 (2.6%) were tested for SARS-CoV-2 infection and 3686 had positive results (overall incidence, 105.9 per 100 000 persons; by racial group, White, 55.1; African American, 123.1; Hispanic, 219.6; Asian, 111.7; other/unknown, 79.3). African American persons had the highest unadjusted testing and mortality rates, White persons had the lowest testing rates, and those with other or unknown race had the lowest mortality rates. Compared with White persons, adjusted testing rates among non-White persons were marginally higher, but infection rates were significantly higher; adjusted odds ratios [aORs] for African American persons, Hispanic persons, Asian persons, and persons of other/unknown race were 2.01 (95% CI, 1.75 to 2.31), 3.93 (CI, 3.59 to 4.30), 2.19 (CI, 1.98 to 2.42), and 1.57 (CI, 1.38 to 1.78), respectively. Geographic analyses showed that infections clustered in areas with higher proportions of non-White persons. Compared with White persons, adjusted hospitalization rates for African American persons, Hispanic persons, Asian persons, and persons of other/unknown race were 1.47 (CI, 1.03 to 2.09), 1.42 (CI, 1.11 to 1.82), 1.47 (CI, 1.13 to 1.92), and 1.03 (CI, 0.72 to 1.46), respectively. Adjusted analyses showed no racial differences in inpatient mortality or total mortality during the study period. For testing, comorbid conditions made the greatest relative contribution to model explanatory power (77.9%); race only accounted for 8.1%. Likelihood of infection was largely due to race (80.3%). For other outcomes, age was most important; race only contributed 4.5% for hospitalization, 12.8% for admission illness severity, 2.3% for in-hospital death, and 0.4% for any death.

LIMITATION

The study involved an insured population in a highly integrated health system.

CONCLUSION

Race was the most important predictor of SARS-CoV-2 infection. After infection, race was associated with increased hospitalization risk but not mortality.

PRIMARY FUNDING SOURCE

The Permanente Medical Group, Inc.

Authors+Show Affiliations

Kaiser Permanente, Oakland, California (G.J.E., L.S., G.T.R., C.L.).Stanford Cancer Institute, Stanford, California (A.S.A.).Kaiser Permanente, Oakland, and Kaiser Permanente Medical Center, Santa Clara, California (V.X.L.).Kaiser Permanente, Oakland, California (G.J.E., L.S., G.T.R., C.L.).The Permanente Medical Group, Inc., Oakland, California (Y.I.C., S.M.P.).The Permanente Medical Group, Inc., Oakland, California (Y.I.C., S.M.P.).Kaiser Permanente, Oakland, California (G.J.E., L.S., G.T.R., C.L.).Kaiser Permanente, Oakland, and Kaiser Permanente Medical Center, Walnut Creek, California (L.C.M.).Kaiser Permanente Medical Center, San Jose, California (C.M.R.).Kaiser Permanente Medical Center, Martinez, California (R.D.).Kaiser Permanente, Oakland, California (G.J.E., L.S., G.T.R., C.L.).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33556278

Citation

Escobar, Gabriel J., et al. "Racial Disparities in COVID-19 Testing and Outcomes : Retrospective Cohort Study in an Integrated Health System." Annals of Internal Medicine, vol. 174, no. 6, 2021, pp. 786-793.
Escobar GJ, Adams AS, Liu VX, et al. Racial Disparities in COVID-19 Testing and Outcomes : Retrospective Cohort Study in an Integrated Health System. Ann Intern Med. 2021;174(6):786-793.
Escobar, G. J., Adams, A. S., Liu, V. X., Soltesz, L., Chen, Y. I., Parodi, S. M., Ray, G. T., Myers, L. C., Ramaprasad, C. M., Dlott, R., & Lee, C. (2021). Racial Disparities in COVID-19 Testing and Outcomes : Retrospective Cohort Study in an Integrated Health System. Annals of Internal Medicine, 174(6), 786-793. https://doi.org/10.7326/M20-6979
Escobar GJ, et al. Racial Disparities in COVID-19 Testing and Outcomes : Retrospective Cohort Study in an Integrated Health System. Ann Intern Med. 2021;174(6):786-793. PubMed PMID: 33556278.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial Disparities in COVID-19 Testing and Outcomes : Retrospective Cohort Study in an Integrated Health System. AU - Escobar,Gabriel J, AU - Adams,Alyce S, AU - Liu,Vincent X, AU - Soltesz,Lauren, AU - Chen,Yi-Fen Irene, AU - Parodi,Stephen M, AU - Ray,G Thomas, AU - Myers,Laura C, AU - Ramaprasad,Charulata M, AU - Dlott,Richard, AU - Lee,Catherine, Y1 - 2021/02/09/ PY - 2021/2/9/pubmed PY - 2021/6/29/medline PY - 2021/2/8/entrez SP - 786 EP - 793 JF - Annals of internal medicine JO - Ann Intern Med VL - 174 IS - 6 N2 - BACKGROUND: Racial disparities exist in outcomes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. OBJECTIVE: To evaluate the contribution of race/ethnicity in SARS-CoV-2 testing, infection, and outcomes. DESIGN: Retrospective cohort study (1 February 2020 to 31 May 2020). SETTING: Integrated health care delivery system in Northern California. PARTICIPANTS: Adult health plan members. MEASUREMENTS: Age, sex, neighborhood deprivation index, comorbid conditions, acute physiology indices, and race/ethnicity; SARS-CoV-2 testing and incidence of positive test results; and hospitalization, illness severity, and mortality. RESULTS: Among 3 481 716 eligible members, 42.0% were White, 6.4% African American, 19.9% Hispanic, and 18.6% Asian; 13.0% were of other or unknown race. Of eligible members, 91 212 (2.6%) were tested for SARS-CoV-2 infection and 3686 had positive results (overall incidence, 105.9 per 100 000 persons; by racial group, White, 55.1; African American, 123.1; Hispanic, 219.6; Asian, 111.7; other/unknown, 79.3). African American persons had the highest unadjusted testing and mortality rates, White persons had the lowest testing rates, and those with other or unknown race had the lowest mortality rates. Compared with White persons, adjusted testing rates among non-White persons were marginally higher, but infection rates were significantly higher; adjusted odds ratios [aORs] for African American persons, Hispanic persons, Asian persons, and persons of other/unknown race were 2.01 (95% CI, 1.75 to 2.31), 3.93 (CI, 3.59 to 4.30), 2.19 (CI, 1.98 to 2.42), and 1.57 (CI, 1.38 to 1.78), respectively. Geographic analyses showed that infections clustered in areas with higher proportions of non-White persons. Compared with White persons, adjusted hospitalization rates for African American persons, Hispanic persons, Asian persons, and persons of other/unknown race were 1.47 (CI, 1.03 to 2.09), 1.42 (CI, 1.11 to 1.82), 1.47 (CI, 1.13 to 1.92), and 1.03 (CI, 0.72 to 1.46), respectively. Adjusted analyses showed no racial differences in inpatient mortality or total mortality during the study period. For testing, comorbid conditions made the greatest relative contribution to model explanatory power (77.9%); race only accounted for 8.1%. Likelihood of infection was largely due to race (80.3%). For other outcomes, age was most important; race only contributed 4.5% for hospitalization, 12.8% for admission illness severity, 2.3% for in-hospital death, and 0.4% for any death. LIMITATION: The study involved an insured population in a highly integrated health system. CONCLUSION: Race was the most important predictor of SARS-CoV-2 infection. After infection, race was associated with increased hospitalization risk but not mortality. PRIMARY FUNDING SOURCE: The Permanente Medical Group, Inc. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/33556278/Racial_Disparities_in_COVID_19_Testing_and_Outcomes_:_Retrospective_Cohort_Study_in_an_Integrated_Health_System_ DB - PRIME DP - Unbound Medicine ER -