What is the key question: Do race and ethnic disparities exist in susceptibility to SARS-CoV-2 infection and how can these disparities be explained?What is the bottom line: African American race and Hispanic ethnicity are associated with higher likelihood of SARS-CoV-2 infection, potentially mediated by residence in high population density areas.
Why read on:We provide novel estimates of higher likelihood of race and ethnic disparities in susceptibility to the SARS-CoV-2 infection from a large heterogenous metropolitan in the U.S.
AbstractIntroduction: Data on race and ethnic susceptibility to SARS-CoV-2 infection are limited. We analyzed socio-demographic factors associated with higher likelihood of SARS-CoV-2 infection and explore mediating pathways for race disparities in the SARS-CoV-2 pandemic.Methods: Cross sectional analysis of COVID-19 Surveillance and Outcomes Registry (CURATOR), which captures data for a large healthcare system comprising of one central tertiary care, seven large community hospitals, and an expansive ambulatory / emergency care network in the Greater Houston area. Nasopharyngeal samples for individuals inclusive of all ages, races, ethnicities and sex were tested for SARS-CoV-2. We analyzed, socio-demographic (age, sex, race, ethnicity, household income, residence population density) and comorbidity (hypertension, diabetes, obesity, cardiac disease) factors. Multivariable logistic regression models were fitted to provide adjusted Odds Ratios (aOR), 95% confidence intervals (CI) for likelihood 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.
Results: Among 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 lower socio-economic status, higher comorbidity burden, and 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 All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.