Black-White Risk Differentials in COVID-19 (SARS-COV2) Transmission, Mortality and Case Fatality in the United States: Translational Epidemiologic Perspective and Challenges
Black-White Risk Differentials in COVID-19 (SARS-COV2) Transmission, Mortality and Case Fatality in the United States: Translational Epidemiologic Perspective and Challenges
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DOI：
10.3390/ijerph17124322
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发表时间：
2020-06-01
影响因子：
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通讯作者：
Dabney, Kirk W.
中科院分区：
文献类型：
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作者：
Holmes, Laurens, Jr.;Enwere, Michael;Dabney, Kirk W.
背景：社会和卫生不平等使弱势群体容易受到流行病和大流行的不良发病率和死亡率后果的影响。1918年和2009年流感大流行的累积发病率和死亡率方面的种族差异表明，在美国，黑人相对于白人处于生存劣势，而新冠肺炎目前显示出类似的差异。我们的目标是：(A)通过种族评估新冠肺炎CMI，(B)确定黑白病例死亡率(CF)和风险差异，以及(C)应用死亡率风险差异的解释性模型。方法：采用横断面生态设计对选定州卫生部门的新冠肺炎确诊病例和死亡数据进行评估。CF独立性采用卡方检验，黑白风险差异采用二项回归模型。结果：新冠肺炎死亡率指数显示，黑人/再生障碍性贫血占美国总死亡率的34%，尽管他们的人口规模为13%。在黑人/AA中，新冠肺炎的CF高于白人；马里兰州(2.7%比2.5%)、威斯康星州(7.4%比4.8%)、伊利诺伊州(4.8%比4.2%)、芝加哥(5.9%比3.2%)、底特律(密歇根州)，7.2%和圣约翰浸信会(路易斯安那州)，7.9%。在密歇根州，黑人/AA比白人死亡的可能性高15%，CMI风险比(CmIRR)=1.15，95%CI，1.01-1.32。在伊利诺伊州，黑人/AA比白人死亡的可能性高13%，CmIRR=1.13，95%CI，0.93-1.39；而在威斯康星州，黑人/AA比白人死亡的可能性高51%，CmIRR=1.51，95%CI，1.10-2.10。在芝加哥，黑人/AA死亡的可能性是后者的两倍多，CmIRR=2.24，95%CI，1.36-3.88。结论：在新冠肺炎患者中观察到明显的种族/民族差异和死亡率，黑人/再生障碍性贫血在全美范围内受到不成比例的影响。
Background: Social and health inequities predispose vulnerable populations to adverse morbidity and mortality outcomes of epidemics and pandemics. While racial disparities in cumulative incidence (CmI) and mortality from the influenza pandemics of 1918 and 2009 implicated Blacks with survival disadvantage relative to Whites in the United States, COVID-19 currently indicates comparable disparities. We aimed to: (a) assess COVID-19 CmI by race, (b) determine the Black-White case fatality (CF) and risk differentials, and (c) apply explanatory model for mortality risk differentials. Methods: COVID-19 data on confirmed cases and deaths by selective states health departments were assessed using a cross-sectional ecologic design. Chi-square was used for CF independence, while binomial regression model for the Black-White risk differentials. Results: The COVID-19 mortality CmI indicated Blacks/AA with 34% of the total mortality in the United States, albeit their 13% population size. The COVID-19 CF was higher among Blacks/AA relative to Whites; Maryland, (2.7% vs. 2.5%), Wisconsin (7.4% vs. 4.8%), Illinois (4.8% vs. 4.2%), Chicago (5.9% vs. 3.2%), Detroit (Michigan), 7.2% and St. John the Baptist Parish (Louisiana), 7.9%. Blacks/AA compared to Whites in Michigan were 15% more likely to die, CmI risk ratio (CmIRR) = 1.15, 95% CI, 1.01-1.32. Blacks/AA relative to Whites in Illinois were 13% more likely to die, CmIRR = 1.13, 95% CI, 0.93-1.39, while Blacks/AA compared to Whites in Wisconsin were 51% more likely to die, CmIRR = 1.51, 95% CI, 1.10-2.10. In Chicago, Blacks/AA were more than twice as likely to die, CmIRR = 2.24, 95% CI, 1.36-3.88. Conclusion: Substantial racial/ethnic disparities are observed in COVID-19 CF and mortality with Blacks/AA disproportionately affected across the United States.