Geographic and temporal variation in racial and ethnic disparities in SARS-CoV-2 positivity between February 2020 and August 2021 in the United States

AbstractThe coronavirus pandemic has disproportionally impacted racial and ethnic minority communities in the United States. Patterns of these disparities may be changing over time as outbreaks occur in different communities. Utilizing electronic health record data from the US Department of Veterans Affairs (VA), we estimated odds ratios, stratified by time period and region, for testing positive among 1,313,402 individuals tested for SARS-CoV-2 between February 12, 2020 and August 16, 2021 at VA medical facilities. We adjusted for personal characteristics (sex, age, rural/urban residence, VA facility) and a wide range of clinical characteristics that have been evaluated in prior SARS-CoV-2 reports and could potentially explain racial/ethnic disparities in SARS-CoV-2. Our study found racial and ethnic disparities for testing positive were most pronounced at the beginning of the pandemic and decreased over time. A key finding was that the disparity among Hispanic individuals attenuated but remained elevated, while disparities among Asian individuals reversed by March 1, 2021. The variation in racial and ethnic disparities in SARS-CoV-2 positivity by time and region, independent of underlying health status and other demographic characteristics in a nationwide cohort, provides important insight for strategies to prevent further outbreaks.

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Racial and ethnic disparities for SARS-CoV-2 positivity in the United States: a generalizing pandemic

10.1101/2021.04.27.21256215 ◽

2021 ◽

Author(s):

Jacqueline M. Ferguson ◽

Amy C. Justice ◽

Thomas F. Osborne ◽

Hoda S. Abdel Magid ◽

Amanda L. Purnell ◽

...

Keyword(s):

United States ◽

Ethnic Disparities ◽

The United States ◽

Racial And Ethnic Disparities ◽

Department Of Veterans Affairs ◽

Key Factors ◽

Electronic Health Record Data ◽

Entire Study ◽

Time Period ◽

Over Time

AbstractThe coronavirus pandemic has disproportionally impacted racial and ethnic minority communities in the United States. These disparities may be changing over time as outbreaks occur in different communities. Using electronic health record data from the Department of Veterans Affairs, we estimated odds ratios, stratified by region and time period, for testing positive for SARS-CoV-2 among 951,408 individuals tested for SARS-CoV-2 between February 12, 2020 and February 12, 2021. Our study found racial and ethnic disparities for testing positive were most pronounced at the beginning of the pandemic and decreased over time. A key finding was that the disparity among Hispanic individuals attenuated but remained elevated over the entire study period. We identified variation in racial and ethnic disparities in SARS-CoV-2 positivity by time and region independent of underlying health status and other key factors in a nationwide cohort, which provides important insight for strategies to contain and prevent further outbreaks.

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Deaths among COVID Cases in the United States: Racial and Ethnic Disparities Persist

10.1101/2020.11.15.20232066 ◽

2020 ◽

Author(s):

Madeleine Short Fabic ◽

Yoonjoung Choi ◽

David Bishai

Keyword(s):

United States ◽

Disease Control ◽

Older Patients ◽

Ethnic Disparities ◽

Case Fatality ◽

The United States ◽

Racial And Ethnic Disparities ◽

Younger Patients ◽

Control And Prevention ◽

Over Time

AbstractUsing COVID-19 Case Surveillance Public Use Data by the Centers for Disease Control and Prevention, we estimate monthly age-adjusted case fatality rates (CFR) for four major groups: non-Hispanic (NH) whites, NH Blacks, NH Asians, and Hispanics. Available data show that CFRs across race/ethnic groups have become more equal over time. Nevertheless, racial and ethnic disparities persist. NH whites consistently experience lower CFRs; NH Blacks generally experience higher case fatality among younger patients; and NH Asians generally experience higher case fatality among older patients. Age-adjusted CFRs reveal dramatically different racial and ethnic disparities that are hidden by crude CFRs. Such adjustment is imperative for understanding COVID-19’s toll.

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Covid-19 by Race and Ethnicity: A National Cohort Study of 6 Million United States Veterans

10.1101/2020.05.12.20099135 ◽

2020 ◽

Cited By ~ 14

Author(s):

Christopher T. Rentsch ◽

Farah Kidwai-Khan ◽

Janet P. Tate ◽

Lesley S. Park ◽

Joseph T. King ◽

...

Keyword(s):

United States ◽

Cohort Study ◽

Race And Ethnicity ◽

Ethnic Disparities ◽

The United States ◽

United States Department ◽

Department Of Veterans Affairs ◽

Wide Range ◽

National Cohort ◽

Race Ethnicity

Background: There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of morbidity and mortality from symptomatic SARS-Cov-2 infection or coronavirus disease 2019 (Covid-19). Most studies investigating racial and ethnic disparities to date have focused on hospitalized patients or have not characterized who received testing or those who tested positive for Covid-19. Objective: To compare patterns of testing and test results for coronavirus 2019 (Covid-19) and subsequent mortality by race and ethnicity in the largest integrated healthcare system in the United States. Design: Retrospective cohort study. Setting: United States Department of Veterans Affairs (VA). Participants: 5,834,543 individuals in care, among whom 62,098 were tested and 5,630 tested positive for Covid-19 between February 8 and May 4, 2020. Exposures: Self-reported race/ethnicity. Main outcome measures: We evaluated associations between race/ethnicity and receipt of Covid-19 testing, a positive test result, and 30-day mortality, accounting for a wide range of demographic and clinical risk factors including comorbid conditions, site of care, and urban versus rural residence. Results: Among all individuals in care, 74% were non-Hispanic white (white), 19% non-Hispanic black (black), and 7% Hispanic. Compared with white individuals, black and Hispanic individuals were more likely to be tested for Covid-19 (tests per 1000: white=9.0, [95% CI 8.9 to 9.1]; black=16.4, [16.2 to 16.7]; and Hispanic=12.2, [11.9 to 12.5]). While individuals from minority backgrounds were more likely to test positive (black vs white: OR 1.96, 95% CI 1.81 to 2.12; Hispanic vs white: OR 1.73, 95% CI 1.53 to 1.96), 30-day mortality did not differ by race/ethnicity (black vs white: OR 0.93, 95% CI 0.64 to 1.33; Hispanic vs white: OR 1.07, 95% CI 0.61 to 1.87). Conclusions: Black and Hispanic individuals are experiencing an excess burden of Covid-19 not entirely explained by underlying medical conditions or where they live or receive care. While there was no observed difference in mortality by race or ethnicity, our findings may underestimate risk in the broader US population as health disparities tend to be reduced in VA.

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