Pseudo-likelihood based logistic regression for estimating COVID-19 infection and case fatality rates by gender, race, and age in California

Abstract

In emerging epidemics, early estimates of key epidemiological characteristics of the disease are critical for guiding public policy. In particular, identifying high-risk population subgroups aids policymakers and health officials in combating the epidemic. This has been challenging during the coronavirus disease 2019 (COVID-19) pandemic because governmental agencies typically release aggregate COVID-19 data as summary statistics of patient demographics. These data may identify disparities in COVID-19 outcomes between broad population subgroups, but do not provide comparisons between more granular population subgroups defined by combinations of multiple demographics. We introduce a method that helps to overcome the limitations of aggregated summary statistics and yields estimates of COVID-19 infection and case fatality rates — key quantities for guiding public policy related to the control and prevention of COVID-19 — for population subgroups across combinations of demographic characteristics. Our approach uses pseudo-likelihood based logistic regression to combine aggregate COVID-19 case and fatality data with population-level demographic survey data to estimate infection and case fatality rates for population subgroups across combinations of demographic characteristics. We illustrate our method on California COVID-19 data to estimate test-based infection and case fatality rates for population subgroups defined by gender, age, and race/ethnicity. Our analysis indicates that in California, males have higher test-based infection rates and test-based case fatality rates across age and race/ethnicity groups, with the gender gap widening with increasing age. Although elderly infected with COVID-19 are at an elevated risk of mortality, the test-based infection rates do not increase monotonically with age. The workforce population, especially, has a higher test-based infection rate than children, adolescents, and other elderly people in their 60–80. LatinX and African Americans have higher test-based infection rates than other race/ethnicity groups. The subgroups with the highest 5 test-based case fatality rates are all-male groups with race as African American, Asian, Multi-race, LatinX, and White, followed by African American females, indicating that African Americans are an especially vulnerable California subpopulation.

Risk Factors for SARS-CoV-2 Infection, Pneumonia, Intubation, and Death in Northeast Mexico

“…An important finding of this study is the mean age of the infected patients, which was younger than that of those who developed complications. This agrees with the estimates of Xiong et al ( 14 ) in California, who found that the highest infection rate was in the population aged 18–59 years, that is, the economically active population, but there was a higher fatality rate in the population aged ≥60 years. In accordance with this finding, the higher infection rate in younger individuals seems to be related to the need to work outside home ( 14 ), whereas the higher severity and lethality seems to be explained by immunosenescence, a chronic low-grade systemic inflammation that has been proposed as a common factor resulting in greater susceptibility to COVID-19 severity ( 22 ).…”

“…The closure of many productive activities due to the pandemic caused the loss of thousands of jobs, which triggered a growth in informal economic activities ( 13 ). In many cases, these circumstances prevented home office work, which could cause greater exposure to infected people and a greater spread of COVID-19 in this population ( 14 ). Moreover, this state has a high prevalence of chronic diseases such as obesity, diabetes and hypertension ( 15 ), which have consistently been associated with infection ( 16 , 17 ) and worse outcomes in the course of this disease ( 4 – 9 , 18 , 19 ).…”

Therapeutic application of estrogen for COVID-19: Attenuation of SARS-CoV-2 spike protein and IL-6 stimulated, ACE2-dependent NOX2 activation, ROS production and MCP-1 upregulation in endothelial cells

“…The gender ratios (males vs. females) for mortality from COVID-10 ranged from 1.46 (10–19 years old age group) to 2.56 (60–69 years old age group) [ 59 ], indicating constantly higher mortality in males. Furthermore, sex difference was demonstrated in COVID-19 patients with different ethnic backgrounds, according to a study conducted in 848,166 patients with COVID-19, for which data were collected from daily COVID-19 report from the California Department of Public Health (CDPH) [ 60 ]. Males had higher rates of mortality resulted from COVID-19 than females across all age groups (0–34, 35–49, 50–59, 60–64, 65–69, 70–74, 75–79, 80+) and different ethnic backgrounds [ 60 ].…”

Death Toll of COVID-19 on Asian Americans: Disparities Revealed

“…9 While early studies were limited to specific states and counties and unadjusted, numerous subsequent studies confirmed a higher COVID-19 CFR for Asian Americans. [10][11][12][13][14][15][16] One of the largest studies to date is a Kaiser Family Foundation (KFF) analysis that used EPIC electronic health record (EHR) data of 332,956 COVID-19 patients from 399 hospitals across 21 states. 15 Compared to the U.S. population, the KFF sample had higher shares of Black and White patients and lower shares of Hispanic and Asian patients, although Asian patients still comprised 3% of the active patient population and about 11,000 COVID-positive cases.…”