Racial Disparities in COVID-19 Testing and Outcomes Retrospective Cohort Study in an Integrated Health System
Racial Disparities in COVID-19 Testing and Outcomes Retrospective Cohort Study in an Integrated Health System
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DOI：
10.7326/m20-6979
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发表时间：
2021-06-01
影响因子：
39.2
通讯作者：
Lee, Catherine
中科院分区：
文献类型：
--
作者：
Escobar, Gabriel J.;Adams, Alyce S.;Lee, Catherine
背景资料：严重急性呼吸综合征冠状病毒2型感染后的结果存在种族差异目的：评价人种/种族在SARS-CoV-2检测、感染和结局中的作用。设计：回顾性队列研究（2020年2月1日至2020年5月31日）。地点：北方加州的综合医疗保健提供系统。参与者：成人健康计划成员。测量：年龄、性别、邻里贫困指数、共病情况、急性生理指标和种族/民族; SARS-CoV-2检测和阳性检测结果的发生率;住院情况、疾病严重程度和死亡率。结果：在3481716名合格成员中，42.0%为白色，6.4%为非洲裔美国人，19.9%为西班牙裔，18.6%为亚洲人; 13.0%为其他人种或未知人种。在符合条件的成员中，91212人（2.6%）接受了SARS-CoV-2感染检测，3686人结果呈阳性（总发病率为每10万人105.9人;按种族分组，白色人为55.1人;非洲裔美国人为123.1人;西班牙裔美国人为219.6人;亚裔为111.7人;其他/未知为79.3人）。非裔美国人有最高的未经调整的测试和死亡率，白色人有最低的测试率，和那些与其他或未知种族的死亡率最低。与白色人相比，非白色人的调整后检测率略高，但感染率明显更高;非裔美国人、西班牙裔美国人、亚裔美国人和其他/未知人种的校正优势比[aOR]为2.01（95%CI，1.75至2.31）、3.93（CI，3.59至4.30）、2.19（CI，1.98至2.42）和1.57（CI，1.38至1.78）。地理分析表明，感染集中在非白人比例较高的地区。与白色人群相比，非裔美国人、西班牙裔人群、亚裔人群和其他/未知人种人群的调整后住院率分别为1.47（CI，1.03 - 2.09）、1.42（CI，1.11 - 1.82）、1.47（CI，1.13 - 1.92）和1.03（CI，0.72 - 1.46）。调整后的分析显示，在研究期间，住院死亡率或总死亡率没有种族差异。对于测试，共病条件作出了最大的相对贡献模型的解释能力（77.9%），种族只占8.1%。感染的可能性很大程度上是由于种族（80.3%）。对于其他结果，年龄是最重要的;种族只贡献了4.5%的住院，12.8%的入院疾病严重程度，2.3%的住院死亡，和0.4%的任何death.Limitation：这项研究涉及的保险人口在一个高度整合的卫生系统。感染后，种族与住院风险增加相关，但与死亡率无关。
Background: Racial disparities exist in outcomes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection.Objective: To evaluate the contribution of race/ethnicity in SARS-CoV-2 testing, infection, and outcomes.Design: Retrospective cohort study (1 February 2020 to 31 May 2020).Setting: Integrated health care delivery system in Northern California.Participants: Adult health plan members.Measurements: Age, sex, neighborhood deprivation index, comorbid conditions, acute physiology indices, and race/ethnicity; SARS-CoV-2 testing and incidence of positive test results; and hospitalization, illness severity, and mortality.Results: Among 3 481 716 eligible members, 42.0% were White, 6.4% African American, 19.9% Hispanic, and 18.6% Asian; 13.0% were of other or unknown race. Of eligible members, 91 212 (2.6%) were tested for SARS-CoV-2 infection and 3686 had positive results (overall incidence, 105.9 per 100 000 persons; by racial group, White, 55.1; African American, 123.1; Hispanic, 219.6; Asian, 111.7; other/unknown, 79.3). African American persons had the highest unadjusted testing and mortality rates, White persons had the lowest testing rates, and those with other or unknown race had the lowest mortality rates. Compared with White persons, adjusted testing rates among non-White persons were marginally higher, but infection rates were significantly higher; adjusted odds ratios [aORs] for African American persons, Hispanic persons, Asian persons, and persons of other/unknown race were 2.01 (95% CI, 1.75 to 2.31), 3.93 (CI, 3.59 to 4.30), 2.19 (CI, 1.98 to 2.42), and 1.57 (CI, 1.38 to 1.78), respectively. Geographic analyses showed that infections clustered in areas with higher proportions of nonWhite persons. Compared with White persons, adjusted hospitalization rates for African American persons, Hispanic persons, Asian persons, and persons of other/unknown race were 1.47 (CI, 1.03 to 2.09), 1.42 (CI, 1.11 to 1.82), 1.47 (CI, 1.13 to 1.92), and 1.03 (CI, 0.72 to 1.46), respectively. Adjusted analyses showed no racial differences in inpatient mortality or total mortality during the study period. For testing, comorbid conditions made the greatest relative contribution to model explanatory power (77.9%); race only accounted for 8.1%. Likelihood of infection was largely due to race (80.3%). For other outcomes, age was most important; race only contributed 4.5% for hospitalization, 12.8% for admission illness severity, 2.3% for in-hospital death, and 0.4% for any death.Limitation: The study involved an insured population in a highly integrated health system.Conclusion: Race was the most important predictor of SARS-CoV-2 infection. After infection, race was associated with increased hospitalization risk but not mortality.