Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study.
Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study.
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DOI：
10.1371/journal.pmed.1003379
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发表时间：
2020-09
期刊：
影响因子：
15.8
通讯作者：
Justice AC
中科院分区：
文献类型：
--
作者：
Rentsch CT;Kidwai-Khan F;Tate JP;Park LS;King JT Jr;Skanderson M;Hauser RG;Schultze A;Jarvis CI;Holodniy M;Lo Re V 3rd;Akgün KM;Crothers K;Taddei TH;Freiberg MS;Justice AC
人们越来越担心，世界各地的种族和少数民族社区正在经历严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染和2019年冠状病毒病(新冠肺炎)的不成比例的负担。我们调查了新冠肺炎检测模式(即谁接受了检测，谁检测呈阳性)以及随后在美国最大的综合医疗体系中的死亡率方面的种族和民族差异。这项回顾性队列研究包括5834,543名在美国退伍军人事务部接受护理的人；大多数(91%)是男性，74%是非西班牙裔白人(白人)，19%是非西班牙裔黑人(黑人)，7%是西班牙裔。我们评估了种族/民族与接受新冠肺炎检测(阳性检测结果)和30天死亡率之间的关系，并对广泛的人口统计和临床特征进行了多变量调整，包括并存条件、健康行为、服药史、护理地点以及城乡居民。在2020年2月8日至7月22日期间，254595人接受了新冠肺炎检测，其中16317人检测呈阳性，1057人死亡。黑人比西班牙裔(52.7，95%CI 52.1-53.4)和白人(38.6，95%CI 38.4-38.7)更有可能接受测试(每1000人中的比率：60.0，95%CI 59.6-60.5)。虽然少数族裔背景的个体更有可能检测出阳性(黑人与白人：优势比[OR]1.93，95%CI 1.85-2.01，p<；0.001；西班牙裔对白人：OR 1.84，95%CI 1.74-1.94，p<；0.001)，但30天的死亡率没有种族/民族的差异(黑人与白人：或0.97，95%CI 0.80-1.17，p=0.74；西班牙裔对白人：OR 0.99，95%CI 0.73-1.34，p=0.94)。新冠肺炎检测阳性的黑人和白人在中西部的差异(OR2.66，95%CI2.41-2.95，p<；0.001)大于西部(OR1.24，95%CI1.11-1.39，p<；0.001)。西班牙裔和白人之间新冠肺炎检测阳性的差异在地区、日历时间和疫情模式之间是一致的。研究的局限性包括妇女代表性不足和缺乏关于健康的社会决定因素的详细信息。在这项全国性的研究中，我们发现黑人和西班牙裔个人正在经历SARS-CoV-2感染的过度负担，这并不完全由潜在的医疗条件或他们在哪里生活或接受护理来解释。迫切需要积极制定战略，以遏制和防止种族和少数民族社区进一步暴发。Christopher Rentsch和他的同事研究了美国退伍军人在新冠肺炎测试和死亡率方面的差异。人们日益关切的是，世界各地的种族和少数民族社区正经历着由有症状的严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染或冠状病毒病2019年(新冠肺炎)造成的不成比例的发病率和死亡率负担。到目前为止，大多数调查种族和民族差异的研究都集中在SARS-CoV-2检测呈阳性的人或住院患者身上。据我们所知，还没有一项研究在全国队列中调查检测模式(即谁接受检测，谁检测呈阳性)以及新冠肺炎结果方面的种族和民族差异，并对潜在的混杂因素进行了适当调整。我们使用了美国最大的综合医疗保健系统的电子健康记录，调查了测试中的种族和民族差异以及随后的新冠肺炎死亡率。即使考虑了其他人口统计学因素、地理位置和潜在的健康状况，非西班牙裔黑人和西班牙裔个体新冠肺炎检测呈阳性的可能性也是非西班牙裔白人个体的两倍。在研究期间，新冠肺炎检测呈阳性的黑人和白人之间的种族差异略有下降，与所有其他地区相比，中西部地区的种族差异最大。在新冠肺炎检测呈阳性的西班牙裔和白人个体之间的种族差异在时间、地理区域和疫情模式上是一致的；这种差异在所有阶层都得到了一致的观察。在新冠肺炎检测呈阳性的人中，按种族/民族分组的30天死亡率没有观察到差异。我们的调查结果突出表明，迫切需要改进战略，以遏制和防止种族和少数民族社区进一步暴发。
There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVID-19 testing (i.e., who received testing and who tested positive) and subsequent mortality in the largest integrated healthcare system in the United States. This retrospective cohort study included 5,834,543 individuals receiving care in the US Department of Veterans Affairs; most (91%) were men, 74% were non-Hispanic White (White), 19% were non-Hispanic Black (Black), and 7% were Hispanic. We evaluated associations between race/ethnicity and receipt of COVID-19 testing, a positive test result, and 30-day mortality, with multivariable adjustment for a wide range of demographic and clinical characteristics including comorbid conditions, health behaviors, medication history, site of care, and urban versus rural residence. Between February 8 and July 22, 2020, 254,595 individuals were tested for COVID-19, of whom 16,317 tested positive and 1,057 died. Black individuals were more likely to be tested (rate per 1,000 individuals: 60.0, 95% CI 59.6–60.5) than Hispanic (52.7, 95% CI 52.1–53.4) and White individuals (38.6, 95% CI 38.4–38.7). While individuals from minority backgrounds were more likely to test positive (Black versus White: odds ratio [OR] 1.93, 95% CI 1.85–2.01, p < 0.001; Hispanic versus White: OR 1.84, 95% CI 1.74–1.94, p < 0.001), 30-day mortality did not differ by race/ethnicity (Black versus White: OR 0.97, 95% CI 0.80–1.17, p = 0.74; Hispanic versus White: OR 0.99, 95% CI 0.73–1.34, p = 0.94). The disparity between Black and White individuals in testing positive for COVID-19 was stronger in the Midwest (OR 2.66, 95% CI 2.41–2.95, p < 0.001) than the West (OR 1.24, 95% CI 1.11–1.39, p < 0.001). The disparity in testing positive for COVID-19 between Hispanic and White individuals was consistent across region, calendar time, and outbreak pattern. Study limitations include underrepresentation of women and a lack of detailed information on social determinants of health. In this nationwide study, we found that Black and Hispanic individuals are experiencing an excess burden of SARS-CoV-2 infection not entirely explained by underlying medical conditions or where they live or receive care. There is an urgent need to proactively tailor strategies to contain and prevent further outbreaks in racial and ethnic minority communities. Christopher Rentsch and colleagues study disparities in COVID-19 testing and mortality among veterans in the United States. There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of morbidity and mortality from symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or coronavirus disease 2019 (COVID-19). Most studies investigating racial and ethnic disparities to date have focused on those who tested positive for SARS-CoV-2 or hospitalized patients. No single study to our knowledge has yet investigated racial and ethnic disparities in testing patterns (i.e., who received testing and who tested positive) as well as COVID-19 outcomes in a nationwide cohort with adequate adjustment for potential confounders. We used electronic health records from the largest integrated healthcare system in the US to investigate racial and ethnic disparities in testing and subsequent COVID-19 mortality. Non-Hispanic Black and Hispanic individuals were twice as likely as non-Hispanic White individuals to test positive for COVID-19, even after accounting for other demographics, geographic location, and underlying health conditions. The racial disparity between Black and White individuals in testing positive for COVID-19 slightly decreased over the study period, and was highest in the Midwest compared to all other regions. The ethnic disparity between Hispanic and White individuals in testing positive for COVID-19 was consistent across time, geographic region, and outbreak pattern; the disparity was consistently observed across all strata. Among those who tested positive for COVID-19, there was no observed difference in 30-day mortality by race/ethnicity group. Our findings highlight the urgent need for improved strategies to contain and prevent further outbreaks in racial and ethnic minority communities.
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DOI：
10.15585/mmwr.mm6915e3
发表时间：
2020-04-17
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Garg S;Kim L;Whitaker M;O'Halloran A;Cummings C;Holstein R;Prill M;Chai SJ;Kirley PD;Alden NB;Kawasaki B;Yousey-Hindes K;Niccolai L;Anderson EJ;Openo KP;Weigel A;Monroe ML;Ryan P;Henderson J;Kim S;Como-Sabetti K;Lynfield R;Sosin D;Torres S;Muse A;Bennett NM;Billing L;Sutton M;West N;Schaffner W;Talbot HK;Aquino C;George A;Budd A;Brammer L;Langley G;Hall AJ;Fry A
通讯作者：
Fry A
影响因子：
4.9
作者：
Abrams, Thad E.;Vaughan-Sarrazin, Mary;Kaboli, Peter J.
通讯作者：
Kaboli, Peter J.
影响因子：
5.5
作者：
Lehavot, Keren;Hoerster, Katherine D.;Simpson, Tracy L.
通讯作者：
Simpson, Tracy L.
影响因子：
16.6
作者：
Griffith GJ;Morris TT;Tudball MJ;Herbert A;Mancano G;Pike L;Sharp GC;Sterne J;Palmer TM;Davey Smith G;Tilling K;Zuccolo L;Davies NM;Hemani G
通讯作者：
Hemani G
影响因子：
5.5
作者：
Hoerster, Katherine D.;Lehavot, Keren;Nelson, Karin M.
通讯作者：
Nelson, Karin M.