Ingraham Nicholas E, Purcell Laura N, Karam Basil S, Dudley R Adams, Usher Michael G, Warlick Christopher A, Allen Michelle L, Melton Genevieve B, Charles Anthony, Tignanelli Christopher J
medRxiv. 2020 Sep 22:2020.09.02.20185983. doi: 10.1101/2020.09.02.20185983.
Background Despite past and ongoing efforts to achieve health equity in the United States, persistent disparities in socioeconomic status along with multilevel racism maintain disparate outcomes and appear to be amplified by COVID-19. Objective Measure socioeconomic factors and primary language effects on the risk of COVID-19 severity across and within racial/ethnic groups. Design Retrospective cohort study. Setting Health records of 12 Midwest hospitals and 60 clinics in the U.S. between March 4, 2020 to August 19, 2020. Patients PCR+ COVID-19 patients. Exposures Main exposures included race/ethnicity, area deprivation index (ADI), and primary language. Main Outcomes and Measures The primary outcome was COVID-19 severity using hospitalization within 45 days of diagnosis. Logistic and competing-risk regression models (censored at 45 days and accounting for the competing risk of death prior to hospitalization) assessed the effects of neighborhood-level deprivation (using the ADI) and primary language. Within race effects of ADI and primary language were measured using logistic regression. Results 5,577 COVID-19 patients were included, 866 (n=15.5%) were hospitalized within 45 days of diagnosis. Hospitalized patients were older (60.9 vs. 40.4 years, p<0.001) and more likely to be male (n=425 [49.1%] vs. 2,049 [43.5%], p=0.002). Of those requiring hospitalization, 43.9% (n=381), 19.9% (n=172), 18.6% (n=161), and 11.8% (n=102) were White, Black, Asian, and Hispanic, respectively. Independent of ADI, minority race/ethnicity was associated with COVID-19 severity; Hispanic patients (OR 3.8, 95% CI 2.72-5.30), Asians (OR 2.39, 95% CI 1.74-3.29), and Blacks (OR 1.50, 95% CI 1.15-1.94). ADI was not associated with hospitalization. Non-English speaking (OR 1.91, 95% CI 1.51-2.43) significantly increased odds of hospital admission across and within minority groups. Conclusions Minority populations have increased odds of severe COVID-19 independent of neighborhood deprivation, a commonly suspected driver of disparate outcomes. Non-English-speaking accounts for differences across and within minority populations. These results support the continued concern that racism contributes to disparities during COVID-19 while also highlighting the underappreciated role primary language plays in COVID-19 severity across and within minority groups.
背景 尽管过去和目前一直在努力在美国实现健康公平，但社会经济地位方面持续存在的差异以及多层次的种族主义导致了不同的结果，而且似乎因2019冠状病毒病（COVID-19）而加剧。目的 衡量社会经济因素和主要语言对不同种族/族裔群体之间以及群体内部COVID-19严重程度风险的影响。设计 回顾性队列研究。地点 2020年3月4日至2020年8月19日期间美国12家中西部医院和60家诊所的健康记录。患者 聚合酶链反应（PCR）检测呈阳性的COVID-19患者。暴露因素 主要暴露因素包括种族/族裔、地区贫困指数（ADI）和主要语言。主要结局和测量指标 主要结局是使用诊断后45天内的住院情况来衡量COVID-19的严重程度。逻辑回归模型和竞争风险回归模型（在45天时进行截尾，并考虑住院前死亡的竞争风险）评估邻里层面贫困（使用ADI）和主要语言的影响。在种族内部，使用逻辑回归测量ADI和主要语言的影响。结果 纳入了5577例COVID-19患者，其中866例（n = 15.5%）在诊断后45天内住院。住院患者年龄更大（60.9岁对40.4岁，p<0.001），且更有可能为男性（n = 425例[49.1%]对2049例[43.5%]，p = 0.002）。在需要住院治疗的患者中，分别有43.9%（n = 381）、19.9%（n = 172）、18.6%（n = 161）和11.8%（n = 102）为白人、黑人、亚洲人和西班牙裔。独立于ADI，少数族裔与COVID-19严重程度相关；西班牙裔患者（比值比[OR] 3.8，95%置信区间[CI] 2.72 - 5.30）、亚洲人（OR 2.39，95% CI 1.74 - 3.29）和黑人（OR 1.50，95% CI 1.15 - 1.94）。ADI与住院无关。非英语使用者（OR 1.91，95% CI 1.51 - 2.43）在少数群体之间以及群体内部显著增加了入院几率。结论 少数族裔人群发生严重COVID-19的几率增加，与邻里贫困无关，而邻里贫困通常被认为是导致不同结果的一个因素。非英语使用者解释了少数群体之间以及群体内部的差异。这些结果支持了人们持续的担忧，即种族主义在COVID-19期间导致了差异，同时也凸显了主要语言在少数群体之间以及群体内部对COVID-19严重程度所起的未得到充分重视的作用。
