4.6 Article

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

Journal

PLOS ONE
Volume 17, Issue 11, Pages -

Publisher

PUBLIC LIBRARY SCIENCE
DOI: 10.1371/journal.pone.0276742

Keywords

-

Funding

  1. NAACCORD Corona-Infectious-Virus Epidemiology Team (CIVET) collaboration
  2. National Institutes of Health [U01AI069918, F31AI124794, F31DA037788, G12MD007583, K01AI093197, K01AI131895, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767]
  3. A National Institutes of Health [U01AI068636, U01AI069432, U01AI069434, U01DA03629, U01DA036935, U10EY008057, U10EY008052, U10EY008067, U01HL146192, U01HL146193, U01HL146194, U01HL146201, U01HL146202]
  4. Centers for Disease Control and Prevention, USA [CDC-200-2006-18797, CDC-200-2015-63931]
  5. Agency for Healthcare Research and Quality, USA [90047713]
  6. Health Resources and Services Administration, USA [90051652]
  7. Canadian Institutes of Health Research, Canada
  8. Ontario Ministry of Health and Long Term Care [CBR-86906, CBR-94036, HCP-97105, TGF-96118]
  9. Government of Alberta, Canada
  10. National Institute Of Allergy And Infectious Diseases (NIAID)
  11. National Cancer Institute (NCI)
  12. National Heart, Lung, and Blood Institute (NHLBI)
  13. Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD)
  14. National Human Genome Research Institute (NHGRI)
  15. National Institute for Mental Health (NIMH)
  16. National Institute on Drug Abuse (NIDA)
  17. National Institute On Aging (NIA)
  18. National Institute Of Dental & Craniofacial Research (NIDCR)
  19. National Institute Of Neurological Disorders And Stroke (NINDS)
  20. National Institute Of Nursing Research (NINR)
  21. National Institute on Alcohol Abuse and Alcoholism (NIAAA)
  22. National Institute on Deafness and Other Communication Disorders (NIDCD)
  23. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) National Institutes of Health
  24. 'National Institutes of Health' [P30AI036219, P30AI050409, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01DA011602, R01DA012568, R01 AG053100, R24AI067039, U01AA013566, U01AA020790, U01AI038855, U01AI038858, U01AI068634]
  25. National Institutes of Health [U01HL146203, U01HL146204, U01HL146205, U01HL146208, U01HL146240, U01HL146241, U01HL146242, U01HL146245, U01HL146333, U24AA020794, U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, Z01CP010214, Z01CP010176]

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This study explores racial/ethnic and sex disparities during the COVID-19 pandemic, even in healthcare settings with reduced barriers to accessing care. Black patients and men are more likely to experience hospitalization and death related to COVID-19.
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.

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