Differences in COVID-19 testing and adverse outcomes by race, ethnicity, sex, and health system setting in a large diverse US cohort.

Autor: Jefferson C; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Mid-Atlantic Permanente Research Institute, Rockville, Maryland, United States of America., Watson E; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Mid-Atlantic Permanente Research Institute, Rockville, Maryland, United States of America., Certa JM; United Health Group, Fredrick, Maryland, United States of America., Gordon KS; Yale School of Medicine, Department of General Internal Medicine, New Haven, Connecticut, United States of America.; VA Connecticut Healthcare System, West Haven, Connecticut, United States of America., Park LS; Stanford Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, United States of America., D'Souza G; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America., Benning L; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America., Abraham AG; Department of Epidemiology, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, United States of America., Agil D; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America., Napravnik S; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America., Silverberg MJ; Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America., Leyden WA; Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America., Skarbinski J; Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America., Williams C; Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America., Althoff KN; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America., Horberg MA; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Mid-Atlantic Permanente Research Institute, Rockville, Maryland, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Nov 23; Vol. 17 (11), pp. e0276742. Date of Electronic Publication: 2022 Nov 23 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0276742
Abstrakt: Background: Racial/ethnic disparities during the first six months of the COVID-19 pandemic led to differences in COVID-19 testing and adverse outcomes. We examine differences in testing and adverse outcomes by race/ethnicity and sex across a geographically diverse and system-based COVID-19 cohort collaboration.
Methods: Observational study among adults (≥18 years) within six US cohorts from March 1, 2020 to August 31, 2020 using data from electronic health record and patient reporting. Race/ethnicity and sex as risk factors were primary exposures, with health system type (integrated health system, academic health system, or interval cohort) as secondary. Proportions measured SARS-CoV-2 testing and positivity; attributed hospitalization and death related to COVID-19. Relative risk ratios (RR) with 95% confidence intervals quantified associations between exposures and main outcomes.
Results: 5,958,908 patients were included. Hispanic patients had the highest proportions of SARS-CoV-2 testing (16%) and positivity (18%), while Asian/Pacific Islander patients had the lowest portions tested (11%) and White patients had the lowest positivity rates (5%). Men had a lower likelihood of testing (RR = 0.90 [0.89-0.90]) and a higher positivity risk (RR = 1.16 [1.14-1.18]) compared to women. Black patients were more likely to have COVID-19-related hospitalizations (RR = 1.36 [1.28-1.44]) and death (RR = 1.17 [1.03-1.32]) compared with White patients. Men were more likely to be hospitalized (RR = 1.30 [1.16-1.22]) or die (RR = 1.70 [1.53-1.89]) compared to women. These racial/ethnic and sex differences were reflected in both health system types.
Conclusions: This study supports evidence of disparities by race/ethnicity and sex during the COVID-19 pandemic that persisted even in healthcare settings with reduced barriers to accessing care. Further research is needed to understand and prevent the drivers that resulted in higher burdens of morbidity among certain Black patients and men.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)
Databáze: MEDLINE
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