Differences in COVID-19-Related Testing and Healthcare Utilization by Race and Ethnicity in the Veterans Health Administration.
Differences in COVID-19-Related Testing and Healthcare Utilization by Race and Ethnicity in the Veterans Health Administration.
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DOI：
10.1007/s40615-021-00982-0
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发表时间：
2022-04
影响因子：
3.9
通讯作者：
Sharafkhaneh A
中科院分区：
文献类型：
--
作者：
Razjouyan J;Helmer DA;Li A;Naik AD;Amos CI;Bandi V;Sharafkhaneh A
最近的报告表明，美国黑人和白人在与 COVID-19 相关的护理和结果方面存在差异。我们按种族和民族检查了退伍军人健康管理局 (VHA) 中接受 SARS-CoV-2 检测的患者与 COVID-19 相关的医疗保健利用率和死亡率。一项回顾性队列研究。我们在2020年2月1日至6月30日期间使用了VHA COVID-19共享数据资源。退伍军人通过VHA进行了SARS-CoV-2病毒检测。由黑人、西班牙裔和白人（作为参考）退伍军人组成的三个种族群体。主要结果是检测率、阳性率、住院率、ICU入住率和院内死亡率。控制性别、年龄和 Elixhauser 合并症指数，我们报告了逻辑回归模型的调整优势比 (aOR) 和 95% 置信区间 (95% CI)。 2020 年 2 月至 6 月，在 8,667,996 名现役退伍军人中，有 252,702 人接受了 VHA 检测，其中 20,500 人结果呈阳性，4,790 人住院。黑人退伍军人的检测率为 4.4%，西班牙裔退伍军人的检测率为 4.7%，而白人退伍军人的检测率为 2.8%。与白人退伍军人（6.0%）相比，黑人退伍军人（12.2%）和西班牙裔退伍军人（11.6%）的检测阳性率同样较高。与白人退伍军人相比，黑人退伍军人（1.88；95% CI 1.74，2.03）和西班牙裔退伍军人（1.41；95% CI 1.25，1.60）住院的 aOR 较高。住院患者入住 ICU 的 OR 或 aOR 和院内死亡没有观察到种族和民族之间存在显着差异。在全国范围内，与白人退伍军人相比，VHA 更有可能对黑人和西班牙裔退伍军人进行检测和住院治疗，但住院患者入住 ICU 或院内死亡率没有显着差异。这种差异模式可能与健康的社会决定因素、影响获得非 VHA 护理的因素或影响初始护理寻求的 VHA 护理偏好有关，但与院内结果无关。在线版本包含可在 10.1007/s40615-021-00982-0 获取的补充材料。
Recent reports indicate differences in COVID-19-related care and outcomes between Black and White Americans. We examine the COVID-19-related healthcare utilization and mortality by race and ethnicity of patients tested for SARS-CoV-2 in the Veterans Health Administration (VHA). A retrospective cohort study. We used the VHA COVID-19 shared data resources between February 1 and June 30, 2020. Veterans tested for SARS-CoV-2 virus by VHA. Three racial-ethnicity groups of Black, Hispanic, and White (as reference) veterans. Main outcomes are testing rate, positivity rate, hospitalization rate, ICU admission rate, and in-hospital mortality. Controlling for sex, age, and Elixhauser comorbidity index, we report adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) from logistic regression models. Of the 8,667,996 active veteran enrollees, 252,702 were tested by VHA from February to June, 2020, with 20,500 positive results and 4,790 hospitalizations. The testing rate was 4.4% among Black and 4.7% among Hispanic veterans compared to White veterans, 2.8%. The testing positivity rate was similarly elevated among Black (12.2%) and Hispanic (11.6%) veterans compared to White veterans (6.0%). The aORs of hospitalization in Black veterans (1.88; 95% CI 1.74, 2.03) and Hispanic veterans (1.41; 95% CI 1.25, 1.60) were higher compared to White veterans. No significant differences by race and ethnicity were observed in OR or aOR of ICU admission and in-hospital death among hospitalized patients. On a national level, the VHA was more likely to test and hospitalize Black and Hispanic veterans compared to White veterans, but there were no significant differences in ICU admission or in-hospital mortality among those hospitalized. This pattern of differences may relate to social determinants of health, factors affecting access to non-VHA care, or preferences for VHA care affecting initial care seeking, but not in-hospital outcomes. The online version contains supplementary material available at 10.1007/s40615-021-00982-0.
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