Nonadherence to Oral 6-Mercaptopurine (6MP) in a Multi-Ethnic Cohort of Children with Acute Lymphoblastic Leukemia (ALL) and Its Impact On Relapse – a Children's Oncology Group (COG) Study (AALL03N1)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 882-882 ◽  
Author(s):  
Smita Bhatia ◽  
Wendy Landier ◽  
Lindsey Hageman ◽  
Heeyoung Kim ◽  
Cara Hanby ◽  
...  
Keyword(s):  
African American ◽  
African Americans ◽  
Low Income ◽  
Systemic Exposure ◽  
Relapse Risk ◽  
Patent Rights ◽  
Asian Children ◽  
Adherence Data ◽  
Risk Of Relapse

Abstract Abstract 882 Background: Nearly 20% of children with ALL relapse within 5y from diagnosis. Second-line therapies are toxic and salvage is poor. Systemic exposure to 6MP is critical for durable remissions; low systemic exposure due to nonadherence to oral 6MP could potentially increase relapse risk. We have previously reported on adherence to oral 6MP in non-Hispanic whites and Hispanics, (J Clin Oncol 2012;30:2094-101); this report extends follow-up for assessment of disease status by 68,250 person-days for non-Hispanic whites and Hispanics; it also includes adherence data for a previously unreported cohort of African American and Asian children. The goal of this report was to: i) describe adherence to oral 6MP in a multi-ethnic cohort of children with ALL; ii) identify determinants of adherence; iii) describe impact of adherence on relapse; and iv) define a clinically-relevant level of adherence needed to minimize relapse risk. Methods: Microprocessor chips in Medication Event Monitoring System (MEMS) caps recorded date/time of 6MP bottle openings for 6 mos/ patient. Adherence rate was defined as days of 6MP bottle opening, divided by days of prescribed 6MP (removing days when 6MP was withheld for toxicity/illness from denominator). Monthly red cell thioguanine nucleotide (TGN) levels were used to demonstrate that MEMS bottle openings were accompanied by 6MP ingestion. Analyses used Generalized Estimating Equations. Results: 462 patients (168 Hispanics; 157 non-Hispanic whites; 69 Asians; 68 African Americans) yielded 76,055 person-days of adherence data. Median age at participation was 6y (2-20); 67% were males; 40% had high-risk disease per NCI criteria; 61% reported income <$50k/y; 14% reported single-caregiver households. Among patients with normal TPMT activity, each 1% increase in MEMS-based adherence was accompanied by a 14 unit (pmol/8·108 red cells) increase in TGN (p=0.01). Adherence declined from mo 1 (94.4%) to mo 6 (89.2%, p<0.0001). Multivariate longitudinal analysis revealed adherence to be significantly lower in adolescents (≥12y: 84.5% vs. <12y: 92.6%, p=0.0003, Fig A); patients from single-caregiver households (87.2% vs. 92.0%, p=0.03, Fig B); patients with low income (<$50k/y: 89.4% vs. ≥$50k/y: 93.8%, p=0.02, Fig C); and Hispanics (90.5±1.6%), Asians (85.3±3.7%) and African Americans (85.3±2.9%) compared with non-Hispanic whites (95.3±1.2%, p<0.0001, Fig D). Adherence for the adolescents (≥12y) from low-income (<$50k/y) families with single-caregivers was significantly lower when compared with that for <12-year-olds from high-income families with multiple caregivers (79.9% vs. 96.7%, p=0.0002); this difference was observed across all racial/ ethnic backgrounds Reasons for missing 6MP included forgetfulness (79%), logistical barriers (19%), and active refusal (2%). After a median follow-up of 5.4y, multivariate analysis (adjusting for clinical/sociodemographic factors) revealed that adherence <95% was associated with an increase in relapse risk (reference: adherence ≥95%; 94.9%-90%: Hazard Ratio [HR]=3.3, 95% Confidence Interval [CI], 1.0–11.6, p=0.06; 89.9%-85%: HR=3.4, 95%CI, 0.9–13.0, p=0.07; <85%: HR=4.5, 95%CI, 1.3–15.1, p=0.02), leading us to use <95% as the cut-point for adherence with a clinically unacceptable increase in relapse. Using this definition, 45% of the patients were non-adherers. The cumulative incidence of relapse was significantly higher among non-adherers (18.8% vs. 4.9%, p=0.0003, Fig E). Furthermore, non-adherers were at a 3.7-fold increased risk of relapse (95%CI, 1.4–10.2, p=0.01), after adjusting for sociodemographic/clinical variables. The adjusted risk of relapse attributable to non-adherence was 47% for this cohort that had entered maintenance in 1st CR. Conclusions: Non-adherence to 6MP is prevalent in children with ALL; 45% consume <95% of prescribed 6MP. Adolescents, Hispanic, African American and Asian children, those with low annual household income, and those from single-caregiver households are more likely to be non-adherent. Forgetfulness is the most common reason for non-adherence. Adherence rates <95% significantly increase relapse risk; 47% of relapses after entry into maintenance are attributable to non-adherence to oral 6MP. Results of this study have led to a COG-wide intervention using cell phone reminders and directly supervised therapy to enhance adherence to oral 6MP. Disclosures: Relling: St. Jude Children's Research Hospital: Dr. Mary Relling receives a portion of the income St. Jude receives from licensing patent rights related to TPMT polymorphisms and GGH polymorphisms. Dr. Mary Relling receives a portion of the income St. Jude receives from licensing patent rights related to TPMT polymorphisms and GGH polymorphisms. Patents & Royalties; Sigma-Tau Pharmaceuticals: Research Funding.

Differential DNA Methylation and Cardiometabolic Risk in African American Mother-Adolescent Dyads

2021 ◽  
pp. 109980042110390
Author(s):  
Amanda Elswick Gentry ◽  
Jo Robins ◽  
Mat Makowski ◽  
Wendy Kliewer
Keyword(s):  
Insulin Resistance ◽  
Cardiovascular Disease ◽  
Dna Methylation ◽  
African American ◽  
African Americans ◽  
Waist Circumference ◽  
Low Income ◽  
Cardiometabolic Risk ◽  
Disease Risk ◽  
Cardiovascular Disease Risk

Background: Cardiovascular disease disproportionately affects African Americans as the leading cause of morbidity and mortality. Among African Americans, compared to other racial groups, cardiovascular disease onset occurs at an earlier age due to a higher prevalence of cardiometabolic risk factors, particularly obesity, hypertension and type 2 diabetes. Emerging evidence suggests that heritable epigenetic processes are related to increased cardiovascular disease risk, but this is largely unexplored in adolescents or across generations. Materials and Methods: In a cross-sectional descriptive pilot study in low-income African American mother-adolescent dyads, we examined associations between DNA methylation and the cardiometabolic indicators of body mass index, waist circumference, and insulin resistance. Results: Four adjacent cytosine and guanine nucleotides (CpG) sites were significantly differentially methylated and associated with C-reactive protein (CRP), 62 with waist circumference, and none to insulin resistance in models for both mothers and adolescents. Conclusion: Further study of the relations among psychological and environmental stressors, indicators of cardiovascular disease, risk, and epigenetic factors will improve understanding of cardiovascular disease risk so that preventive measures can be instituted earlier and more effectively. To our knowledge this work is the first to examine DNA methylation and cardiometabolic risk outcomes in mother-adolescent dyads.

scholarly journals Africultural Coping Systems Inventory: Psychometrics in a Clinical Sample of African American Women

2020 ◽  
Vol 46 (6-7) ◽  
pp. 457-481
Author(s):  
Natalie N. Watson-Singleton ◽  
Devon LoParo ◽  
Yara Mekawi ◽  
Joya N. Hampton-Anderson ◽  
Nadine J. Kaslow
Keyword(s):  
African American ◽  
African Americans ◽  
African American Women ◽  
Low Income ◽  
Clinical Sample ◽  
Reliability And Validity ◽  
General Factor ◽  
American Women ◽  
Structure Reliability ◽  
Clinical Counseling

The Africultural Coping Systems Inventory (ACSI) assesses African Americans’ culturally relevant stress coping strategies. Although its factor structure, reliability, and validity of the scores have been examined across ethnic groups of African descent, psychometric properties have not been investigated in an African American clinical sample. Thus, it is unclear if the ACSI is useful for research with African Americans with distress. To assess the ACSI’s psychometrics, we used data from 193 low-income African American women who in the past year encountered interpersonal trauma and attempted suicide. We tested four models: one-factor, four-factor, four-factor hierarchical, and bifactor. None of the models were optimal, suggesting possible revisions to ACSI items. Yet the bifactor model provided a better fit than other models with items loading onto a general factor and onto specific factors. Internal consistency of the scores was above the recommended criterion (i.e., .70), and the ACSI general factor was related to depressive symptoms, suicidal ideation (but not alcohol abuse), providing some support for its concurrent validity. Future directions, limitations, and clinical-counseling implications are discussed.

scholarly journals Cardiovascular Outcomes in African Americans with Sickle Cell Trait and Chronic Kidney Disease

2019 ◽  
Vol 49 (2) ◽  
pp. 93-102 ◽  
Author(s):  
Kabir O. Olaniran ◽  
Nwamaka D. Eneanya ◽  
Andrew S. Allegretti ◽  
Sophia H. Zhao ◽  
Maureen M. Achebe ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
African American ◽  
Cardiovascular Risk ◽  
African Americans ◽  
Kidney Disease ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
Increased Risk ◽  
The Mean

Background: Sickle cell trait (SCT) is common among African Americans and has been historically considered to be benign. Recently, SCT has been associated with an increased risk for chronic kidney disease (CKD) and cardiovascular disease in the general population. Our understanding of SCT has been extrapolated largely from data of patients with sickle cell disease (SCD). Notably, in SCD, the outcomes differ by sex. The effect of SCT on cardiovascular risk in the African American CKD population is unknown, and the interaction between SCT and sex on cardiovascular risk has not been investigated. Methods: We performed a 2-center retrospective cohort study of all African American patients with SCT using international classification of disease diagnosis codes and CKD (using the 2012 Kidney Disease Improving Global Outcomes criteria) with at least 1 year of follow-up between January 2005 and December 2017. A reference group of ­African American CKD patients without SCT was used as a comparator during the same period. SCT patients and the reference patients were matched at baseline for age, sex, comorbidities, and proteinuria. Primary outcomes were incident coronary artery disease (CAD), incident stroke, and all-cause mortality. Analysis of effect modification between sex and SCT on primary outcomes was performed. Results: We identified 621 African American CKD patients, 217 SCT patients, and 404 reference patients. The mean age was 56 ± 13 years and 66% were female. The mean estimated glomerular filtration rate was 69 ± 30 mL/min. The mean follow-up time was 8 ± 4 years. There were no significant differences in the primary outcomes comparing SCT patients to matched controls. The interaction term between SCT and sex, however, was significant in the CAD model (p < 0.01). Stratification by sex showed no increased risk in females but a significantly increased risk for CAD in male SCT patients (hazard ratio [HR] 2.14; 95% CI 1.18–3.86), which persisted after multivariable analysis (HR 2.13; 95% CI 1.17–3.86). Conclusion: SCT is associated with an increased risk for CAD in African American males with CKD. The excess risk in males with SCT appears to follow the same pattern as risk in males with SCD. Larger studies are needed to confirm these findings.

Pegylated Liposomal Doxorubicin (PLD), Vincristine and Reduced-Dose Dexamethasone (DVd) in the Treatment of a Predominantly African American Population with Multiple Myeloma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2573-2573 ◽  
Author(s):  
Ahmad Jajeh ◽  
Rosalind Catchatourian ◽  
David Osafo ◽  
Deimante Tamkus ◽  
Ghassan Zalzaleh ◽  
...  
Keyword(s):  
African American ◽  
African Americans ◽  
Patient Population ◽  
Liposomal Doxorubicin ◽  
Pegylated Liposomal Doxorubicin ◽  
Mononuclear Phagocytes ◽  
Phospholipid Vesicle ◽  
African American Patient ◽  
Minor Response

Abstract Recently there has been an important recognition of potentially different responses to pharmaceuticals based on genetic predisposition, with the first FDA advisory panel recommending approval of a heart failure drug for African Americans alone. Liposomal doxorubicin (DOXIL; PLD) is a microscopic pegylated phospholipid vesicle with a core containing conventional doxorubicin. The pegylated coat protects the liposomes from detection by mononuclear phagocytes increasing blood circulation time (t½ = 55 hours). Due to its prolonged half-life, PLD provides a similar effect to using continuous infusion doxorubicin, but administered over 1-hour, transforming the regimen into an outpatient treatment. PLD has also been shown to have a significantly better cardiac safety profile than conventional doxorubicin. A phase II trial using DVd was started in October 2000 and is still enrolling (PLD 40 mg/m2, vincristine 2 mg IVP, and dexamethasone 40 mg PO 1–4 d every 4-weeks). Twenty-seven patients have been enrolled (11 males/16 females; mean age 56 years [range 41–75]). The majority of patients enrolled in this study are African American (74%), a patient population not commonly studied. Patients presented with relatively advanced disease (stages II – III). Baseline mean serum albumin level was 3.5 mg/dL (range 1.4 to 4.4), beta-2 microglobulin 3.38 (range 1.0 – 8.97), fourteen patients had IgG Kappa, three patients has IgG Lambda, six patients with IgA, and four patients with light chain disease. Eighteen patients completed six cycles of therapy, with two patients completing five cycles. Six patients underwent autologous bone marrow transplant following their response to DVd. CR, and nCR was achieved in nine patients, partial responses were achieved in seven patients, minor response in two patients, and progressive disease in five patients, based on Blade Response Assessment. Median follow up is twenty-four months (range 3 months – 5 years). Overall medium time to progression is approximately 1 year. Twenty patients are still alive, one patient has been lost to follow up, and six deaths have occurred. Four early deaths were due to disease progression and sepsis. Two died after one year of therapy due to progressive refractory disease. One died after the second cycle because of sudden cardiac death with sepsis. Three of the early deaths had amyloidosis. No episodes of cardiac dysfunction were observed. Conclusion: African Americans have a 3-fold higher risk of cardiac toxicity with conventional doxorubicin. The use of DVd in this predominantly African American patient population was cardiac safe and provided an easy administered outpatient option, with an overall response rate of ~66% in stage II–III patients.

Pegylated Liposomal Doxorubicin (PLD), Vincristine and Reduced-Dose Dexamethasone (DVd) in the Treatment of Predominantly African American Population with Multiple Myeloma.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5105-5105 ◽  
Author(s):  
Anshul Bamrolia ◽  
Ahmad Jajeh ◽  
R. Catchatourian ◽  
David Osafo ◽  
Deimante Tamkus ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
African American ◽  
African Americans ◽  
Liposomal Doxorubicin ◽  
Mononuclear Phagocytes ◽  
Disease Stage ◽  
Phospholipid Vesicle ◽  
American Population ◽  
African American Population

Abstract Biologic therapy is emerging as first line therapy for multiple myeloma. However, most patients will require multiple lines of treatments and chemotherapy remains a very good option. In the last few years, there has been an important recognition of potentially different responses to pharmaceuticals based on genetic predisposition, starting with the FDA advisory panel recommending approval of a heart failure drug for African Americans. Liposomal doxorubicin (DOXIL; PLD) is a microscopic pegylated phospholipid vesicle with a core containing conventional doxorubicin. The pegylated coat protects the liposomes from detection by mononuclear phagocytes, increasing blood circulation time (t1/2=55 hours). Due to its prolonged half life, PLD provides a similar effect to using continuous infusion doxorubicin, but administered over 1-hour, transforming the regimen into an outpatient treatment. PLD has also been shown to have a significantly better safety profile than conventional doxorubicin. We evaluated the efficacy and safety of DVd in a predominantly African American population. A phase II trial using DVd was started in October 2000(PLD 40 mg/m2, vincristine 2 mg IVP and dexamethasone 40 mg PO 1-4 d every 4-weeks). Thirty-four patients have received DVd (15 males/19 females: mean age 59 years [range 42–77]) (five patients were off-study but received DVd per protocol). The majority of patients are African American (70%), a patient population not commonly studied. Patients presented with relatively advanced disease (stage II–III). Baseline mean serum albumin level was 3.5 mg/dl (range 1.8 to 4.9), beta-2 microglobulin 4.09 (range 1.0–8.97). Seventeen patients had IgG Kappa, seven patients had IgG lambda, six patients had IgA and four patients had light chain disease. Twenty five patients completed six cycles of therapy, with two patients completing five cycles. Six patients underwent autologous bone marrow transplant following their response to DVd. Response was assessed on the basis of a reduction of the paraprotein in serum or urine that lasted for at least six weeks. A response was achieved in 27 patients of whom 15 had a CR or nCR. 2 patients had stable disease, and disease progressed in four patients based on Blade Response Assessment. One patient died before response could be assessed. Median follow up is 36 months (range 3 months to 5 years). Our median time to progression is approximately 1 year. Twenty four patients are still alive, one patient has been lost to follow up and nine deaths have occurred. Four early deaths were due to disease progression and sepsis. Three of the early deaths had amyloidosis. Two died after one year of therapy due to progressive refractory disease. One died after the second cycle because of sudden cardiac death with sepsis. No episodes of cardiac dysfunction were observed. For African Americans, who have a high incidence of hypertension, renal and cardiovascular disease, a cardiac safer liposomal doxorubicin may be the preferred form of anthracyline.

Suicide Acceptability and Religious Well-Being: A Comparative Analysis in African American Suicide Attempters and Non-Attempters

2005 ◽  
Vol 33 (2) ◽  
pp. 140-150 ◽  
Author(s):  
Deidre M. Anglin ◽  
Kamieka O. S. Gabriel ◽  
Nadine J. Kaslow
Keyword(s):  
African American ◽  
African Americans ◽  
Low Income ◽  
Well Being ◽  
Self Report ◽  
Culturally Competent ◽  
Suicide Attempters ◽  
Community Programming ◽  
Significant Difference ◽  
Mental Health Programs

This study was designed to examine the relationship between suicide acceptability and religious well-being, and to investigate the differences that may exist between African American suicide attempters and non-attempters on these two concepts. Two hundred low-income, African Americans were administered self-report questionnaires measuring suicide acceptability and religious well-being. Findings indicated that suicide acceptability was negatively related to religious well-being for both suicide attempters and non-attempters. There was also a significant difference between these two groups on suicide acceptability and religious well-being. Results were consistent with previous research that suggests that African Americans who attempt suicide endorse higher levels of suicide acceptability and lower levels of religious well-being than do their nonattempter counterparts. These findings have important implications for culturally-competent community programming and community mental health programs that serve low-income ethnic minority populations.

Smoking Attitudes and Practices among Low-Income African-Americans: Qualitative Assessment of Contributing Factors

2003 ◽  
Vol 17 (4) ◽  
pp. 240-248 ◽  
Author(s):  
Bettina M. Beech ◽  
Isabel C. Scarinci
Keyword(s):  
Young Adults ◽  
African American ◽  
African Americans ◽  
Focus Group ◽  
Focus Groups ◽  
Low Income ◽  
Small Sample ◽  
Attitudes And Practices ◽  
Smoking Attitudes ◽  
American Young Adults

Purpose. Studies have shown that African-American adolescents are less likely to smoke cigarettes than white youth. National data suggest that this pattern changes in late adolescence and early adulthood. Specifically, African-American adults have a relatively high smoking prevalence rate when compared with other racial/ethnic groups. The purpose of this study was to qualitatively examine the sociocultural factors associated with smoking attitudes and practices among low-income African-American young adults. Design. Cross-sectional qualitative study. Settings. High schools, 2-year colleges, housing developments, and trade schools in New Orleans, Louisiana, and Memphis, Tennessee. Subjects. One hundred eighteen low-income African Americans between 18 and 35 years of age (65 men and 53 women). Measure/Procedure. Fourteen focus groups were conducted with the target population. Nonmonetary incentives were provided for each participant in the 1-hour sessions. The majority of focus group moderators were African-American females trained in focus group moderation. Participants were recruited through flyers and project liaisons at each field location. Results. Themes elicited from the focus groups were classified according to the PEN-3 model, and they included: lighting cigarettes for parents as a first experience with cigarettes, perceived stress relief benefits of smoking, use of cigarettes to extend the sensation of marijuana, and protective factors against smoking such as respect for parental rules. Conclusion. The results indicate that there are specific contextual and familial factors that can contribute to smoking initiation, maintenance, and cessation among low-income African-American young adults. Limitations of this study include the exploratory nature of focus groups and the relatively small sample size. Further studies are necessary to quantitatively examine the role of these factors on smoking patterns in this population.

scholarly journals Perspectives from Underserved African Americans and their Healthcare Providers on the Development of a Diabetes Self-Management Smartphone Application: Exploratory Study (Preprint)

2020 ◽  
Author(s):  
Tai Barber-Gumbs ◽  
Ylva Trolle Lagerros ◽  
Laura M. Sena ◽  
Joel Gittelsohn ◽  
Larry W. Chang ◽  
...  
Keyword(s):  
African American ◽  
African Americans ◽  
Low Income ◽  
Diabetes Education ◽  
Healthcare Providers ◽  
Smartphone Application ◽  
Self Management ◽  
The Us ◽  
Management Recommendations ◽  
P Type

BACKGROUND Type 2 diabetes mellitus (T2DM) affects ~10% of the US population, disproportionately affecting African Americans. Smartphone applications (apps) have emerged as promising tools to improve diabetes self-management, yet little is known about the use of this approach in low-income minority communities. OBJECTIVE The goal of the study was to explore which features of an app were prioritized for people with T2DM in a low-income African-American community. METHODS Between February 2016 and May 2018, we conducted formative qualitative research with 78 participants to explore how a smartphone app could be used to improve diabetes self-management. Information was gathered on desired features and app mockups were presented to receive comments and suggestions of improvements from smartphone users with prediabetes/T2DM, their friends and family members, and healthcare providers (in 6 interactive forums, 1 focus group and 15 in-depth interviews). We carried out thematic data analysis using an inductive approach. RESULTS All three types of participants reported that difficulties with access to healthcare was a main problem and suggested that an app could help address this. Participants also indicated that an app could provide information for diabetes education and self-management. Other suggestions included that the app should allow people with T2DM to log and track diabetes care-related behaviors and receive feedback on their progress in a way that would increase a person with T2DM’s engagement in self-management. CONCLUSIONS We identified educational and tracking smartphone features that can guide development of diabetes self-management apps for a low-income African-American population. Considering those features in combination gives rise to opportunities for more advanced support, such as determining self-management recommendations based on data in user's logs. CLINICALTRIAL

scholarly journals Racial and Ethnic Disparities in SARS-CoV-2 Pandemic: Analysis of a COVID-19 Observational Registry for a Diverse U.S. Metropolitan Population

2020 ◽  
Author(s):  
Farhaan S. Vahidy ◽  
Juan Carlos Nicolas ◽  
Jennifer R. Meeks ◽  
Osman Khan ◽  
Stephen L. Jones ◽  
...  
Keyword(s):  
African American ◽  
African Americans ◽  
Population Density ◽  
Low Income ◽  
Ethnic Disparities ◽  
Equation Modeling ◽  
Hispanic Ethnicity ◽  
Race Disparities ◽  
Comorbidity Burden ◽  
African American Race

AbstractImportanceDespite emerging reports of poor COVID-19 outcomes among African Americans, data on race and ethnic susceptibility to SARS-CoV-2 infection are limited.ObjectiveTo determine socio-demographic factors associated with higher likelihood of SARS-CoV-2 infection. To explore mediating pathways for race disparities in the SARS-CoV-2 pandemic.DesignCross sectional analysis of COVID-19 Surveillance and Outcomes Registry (CURATOR). Multivariable logistic regression models were fitted to provide likelihood estimates (adjusted Odds Ratios: aOR, 95% confidence intervals: CI) of positive SARS-CoV-2 test. Structural Equation Modeling (SEM) framework was utilized to explore three mediation pathways (low income, high population density, high comorbidity burden) for association between African American race and SARS-CoV-2 infection.SettingA large healthcare system comprising of one central tertiary care, seven large community hospitals and an expansive ambulatory and emergency care network in the Greater Houston area.ParticipantsIndividuals of all ages, races, ethnicities and sex tested for SARS-CoV-2.ExposureSocio-demographic (age, sex, race, ethnicity, household income, residence population density) and comorbidity (hypertension, diabetes, obesity, cardiac disease) factors.Main OutcomePositive reverse transcriptase polymerized chain reaction test for SARS-CoV-2.ResultsAmong 4,513 tested individuals, 754 (16.7%) tested positive. Overall mean (SD) age was 50.6 (18.9) years, 62% females and 26% were African American. African American race was associated with higher comorbidity burden, lower socio-economic status, and higher population density residence. In the fully adjusted model, African American race (vs. White; aOR, CI: 1.84, 1.49–2.27) and Hispanic ethnicity (vs. non-Hispanic; aOR, CI: 1.70, 1.35–2.14) had a higher likelihood of infection. Older individuals and males were also at a higher risk of SARS-CoV-2 infection. The SEM framework demonstrated a statistically significant (p = 0.008) indirect effect of African American race on SARS-CoV-2 infection mediated via a pathway that included residence in densely populated zip code.Conclusions and RelevanceThere is strong evidence of race and ethnic disparities in the SARS-CoV-2 pandemic potentially mediated through unique social determinants of health.Key PointsQuestionDo race and ethnic disparities exist in susceptibility to SARS-CoV-2 infection and how can these disparities be explained?FindingsAfrican American race and Hispanic ethnicity are associated with higher likelihood of SARS-CoV-2 infection even after adjusting for other important socio-demographic and comorbidity factors. Residence in a high-density population area partially mediated higher susceptibility among African Americans.MeaningMinority race and ethnicity increases susceptibility to SARS-CoV-2 infection in a large U.S. Metropolitan area. Though several factors may increase chances of infection among minorities; residence in population dense areas and therefore inability to adequately practice social distancing may explain higher infectivity.

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