评估纽约州使用 COVID-19 结果连续体的种族和族裔差异。
Assessing racial and ethnic disparities using a COVID-19 outcomes continuum for New York State.
机构信息
Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, State University of New York, Rensselaer; Center For Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer.
Center For Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer; Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer.
出版信息
Ann Epidemiol. 2020 Aug;48:9-14. doi: 10.1016/j.annepidem.2020.06.010. Epub 2020 Jun 29.
PURPOSE
Heightened COVID-19 mortality among Black non-Hispanic and Hispanic communities (relative to white non-Hispanic) is well established. This study aims to estimate the relative contributions to fatality disparities in terms of differences in SARS-CoV-2 infections, diagnoses, and disease severity.
METHODS
We constructed COVID-19 outcome continua (similar to the HIV care continuum) for white non-Hispanic, Black non-Hispanic, and Hispanic adults in New York State. For each stage in the COVID-19 outcome continua (population, infection experience, diagnosis, hospitalization, fatality), we synthesized the most recent publicly available data. We described each continuum using overall percentages, fatality rates, and relative changes between stages, with comparisons between race and ethnicity using risk ratios.
RESULTS
Estimated per-population COVID-19 fatality rates were 0.03%, 0.18%, and 0.12% for white non-Hispanic, Black non-Hispanic, and Hispanic adults, respectively. The 3.48-fold disparity for Hispanic, relative to white, communities was explained by differences in infection experience, whereas the 5.38-fold disparity for non-Hispanic Black, relative to white, communities was primarily driven by differences in both infection experience and in the need for hospitalization, given infection.
CONCLUSIONS
These findings suggest the most impactful stages on which to intervene with programs and policies to build COVID-19 health equity.
目的
黑人和西班牙裔非西班牙裔人群（相对于白种非西班牙裔人群）的 COVID-19 死亡率升高已得到充分证实。本研究旨在根据 SARS-CoV-2 感染、诊断和疾病严重程度的差异，估算导致病死率差异的相对因素。
方法
我们为纽约州的白种非西班牙裔、黑种非西班牙裔和西班牙裔成年人构建了 COVID-19 结局连续体（类似于 HIV 护理连续体）。对于 COVID-19 结局连续体的每个阶段（人群、感染经历、诊断、住院、死亡），我们综合了最新的公开可用数据。我们使用总体百分比、病死率和各阶段之间的相对变化来描述每个连续体，并使用风险比比较种族和族裔之间的差异。
结果
估计白种非西班牙裔、黑种非西班牙裔和西班牙裔成年人的每人口 COVID-19 病死率分别为 0.03%、0.18%和 0.12%。西班牙裔社区与白种社区相比，病死率差异为 3.48 倍，这归因于感染经历的差异；而非西班牙裔黑人社区与白种社区相比，病死率差异为 5.38 倍，这主要归因于感染经历以及在感染情况下住院需求的差异。
结论
这些发现表明，在制定针对 COVID-19 公平性的项目和政策时，最具影响力的阶段是干预这些阶段。
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