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

Abstract

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.

Syndemic Perspectives to Guide Black Maternal Health Research and Prevention During the COVID-19 Pandemic

“…The COVID-19 pandemic is likely to exacerbate existing socioeconomic disparities among BWBP and increase vulnerabilities to COVID-19 acquisition and transmission, especially those vulnerabilities related to employment in low-wage, 'essential' occupations. Because of an array of structural inequalities, including those caused by systemic racism, BWBP are more likely to experience lower socioeconomic status and low incomes (Mein 2020;Vahidy et al 2020). Individuals with lower income are often employed in occupations that render them especially vulnerable to COVID-19 infection and transmission due to increased workplace exposures related to lack of sick leave, inadequate provision of personal protective equipment, and the inability to work from home (Bohn et al 2020;Hooper et al 2020;Mein 2020).…”

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

“…1 There is growing concern that racial and ethnic minority communities are experiencing a disproportionate burden of morbidity and mortality from symptomatic SARS-Cov-2 infection or coronavirus disease 2019 (Covid-19). [2][3][4][5] One report from Milwaukee County, Wisconsin found that Covid-19 cases were largely clustered in predominately African American areas and that this clustering was independent of income. 6 The largest study to date on racial and ethnic disparities in the US conducted by the Centers for Disease Control and Prevention (CDC) found that black individuals were overrepresented in a national sample of 580 patients hospitalized with Covid-19.…”

High prevalence of SARS-CoV-2 infection among symptomatic healthcare workers in a large university tertiary hospital in São Paulo, Brazil

“…There are con icting results in the literature to identify the job category with the highest risk of COVID-19 among HCWs [6,7,11]. In our study, physicians represented the majority of the cases, even though nurses form the largest subset of employees in the hospital.…”

“…Although several studies already investigated the epidemiology of and risk factors for SARS-CoV-2 infection among HCWs in high-income countries, there is a lack of data from low and middle-income countries, where shortage of personal protective equipment (PPE), diagnostic tests and other vital supplies represent one of the most urgent challenges faced by public health systems [4][5][6][7][9][10][11][12][13].…”