Pflugeisen Bethann Mangel, Mou Jin
MultiCare Health System, Institute for Research & Innovation, Tacoma, WA, USA.
Ethn Health. 2021 Jan;26(1):36-48. doi: 10.1080/13557858.2020.1863922. Epub 2021 Jan 11.
Early reports from the initial months of the coronavirus pandemic reveal ethnic disparities in coronavirus incidence, severity, and mortality. This study aimed to evaluate the relationship between ethnicity and outcomes of coronavirus positivity and hospitalization.
An observational cohort study using electronic health record (EHR) data from a large community healthcare system in Washington State across the first phase of the pandemic (March 5 - June 7, 2020).
A total of 18,667 patients (65.9% of all tested) with EHR-documented ethnicity were included. Overall, 6.4% of patients tested positive for coronavirus. Among Latinx patients, 18.6% of those tested were positive, compared to only 4.0% of tested White patients. Multivariable logistic regression revealed significantly higher odds of positivity for Latinxs (aOR = 4.96, 95% CI 4.19-5.87), Asians (aOR = 2.33, 95% CI 1.74-3.08), Blacks (aOR = 1.82, 95% CI 1.43-2.31), and members of other ethnic minority groups (aOR = 2.34, 95% CI 1.80-2.95), compared to Whites in models adjusting for relevant confounders. Latinxs had a higher percentage of self-pay insurance (22.2%) compared to other ethnic groups (7.9-15.8%) and, among those who tested positive, were the only ethnic subpopulation with significantly higher odds than Whites to be hospitalized for COVID-19 (aOR = 2.19, 95% CI 1.45-3.33). We observed a positive correlation between infection and the percentage of Latinxs ( = 0.61, 95% CI 0.45-0.74), Blacks ( = 0.51, 95% CI 0.32-0.66), or Asians ( = 0.64, 95% CI 0.49-0.76) in a given zip-code. This correlationwas negative for Whites ( = -0.63, 95% CI -0.75, -0.45).
We present empirical evidence of higher rates of coronavirus positivity among People of Color compared to White people in Washington State. Social determinants of health, such as occupation, housing, healthcare access, and community structure, may contribute to health disparities in the coronavirus pandemic. Targeted capture of these variables in electronic health records is warranted to inform health equity analyses.
新冠疫情最初几个月的早期报告显示，在新冠病毒的发病率、严重程度和死亡率方面存在种族差异。本研究旨在评估种族与新冠病毒检测呈阳性及住院结果之间的关系。
一项观察性队列研究，使用华盛顿州一个大型社区医疗系统在疫情第一阶段（2020年3月5日至6月7日）的电子健康记录（EHR）数据。
共有18667名有EHR记录种族的患者（占所有检测者的65.9%）被纳入研究。总体而言，6.4%的患者新冠病毒检测呈阳性。在拉丁裔患者中，18.6%的检测者呈阳性，而检测的白人患者中只有4.0%呈阳性。多变量逻辑回归显示，在调整了相关混杂因素的模型中，拉丁裔（调整后比值比[aOR]=4.96，95%置信区间[CI]4.19 - 5.87）、亚裔（aOR = 2.33，95% CI 1.74 - 3.08）、黑人（aOR = 1.82，95% CI 1.43 - 2.31）以及其他少数族裔群体成员（aOR = 2.34，95% CI 1.80 - 2.95）检测呈阳性的几率显著高于白人。与其他族裔群体（7.9% - 15.8%）相比，拉丁裔的自费保险比例更高（22.2%），并且在检测呈阳性的人群中，拉丁裔是唯一一个因新冠病毒住院几率显著高于白人的族裔亚群体（aOR = 2.19，95% CI 1.45 - 3.33）。我们观察到在给定邮政编码区域内，感染率与拉丁裔（r = 0.61，95% CI 0.45 - 0.74）、黑人（r = 0.51，95% CI 0.32 - 0.66）或亚裔（r = 0.64，95% CI 0.49 - 0.76）的比例呈正相关。而与白人的这一相关性为负（r = -0.63，95% CI -0.75，-0.45）。
我们提供了实证证据，表明华盛顿州有色人种的新冠病毒阳性率高于白人。健康的社会决定因素，如职业（应为社会经济地位等因素，原文occupation有误）、住房、医疗保健可及性和社区结构等，可能导致新冠疫情中的健康差异。有必要在电子健康记录中针对性地获取这些变量，以进行健康公平性分析。
