Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA.
JCO Clin Cancer Inform. 2021 Feb;5:168-175. doi: 10.1200/CCI.20.00158.
As health inequities during the pandemic have been magnified, we evaluated how use of SARS-CoV-2 testing differed by race or ethnicity in a large cohort of breast cancer survivors and examined the correlates of testing positive.
We conducted a retrospective cohort study of 22,481 adult breast cancer survivors who were active members of a large California integrated healthcare plan in 2020. We collected data on their breast cancer diagnosis, comorbidity, and demographic characteristics. We examined SARS-CoV-2 testing utilization between March 2020 and September 2020 by race or ethnicity, comorbidity, and other patient characteristics. We also examined the correlates of a having a positive SARS-CoV-2 test result. We conducted bivariable and multivariable logistic regression to identify correlates of testing utilization and test positivity.
Of these 22,481 women, 3,288 (14.6%) underwent SARS-CoV-2 testing. The cohort included 51.8% women of color. Of the 3,288 tested, 264 (8.0%) women had a positive test result. In multivariable analyses, Latinx survivors were more likely (adjusted odds ratio [OR], 1.23; 95% CI, 1.12 to 1.34) to undergo testing than White survivors; however, Asian or Pacific Islander survivors were 16% less likely to get tested (adjusted OR, 0.84; 95% CI, 0.75 to 0.94). Compared to White survivors, Latinx survivors were 3.5 times (adjusted OR, 3.47; 95% CI, 2.52 to 4.77) and Asian or Pacific Islander or Other survivors were 2.2-fold (adjusted OR, 2.23; 95% CI, 1.49 to 3.34) more likely to test positive. Being overweight (adjusted OR, 1.83; 95% CI, 1.24 to 2.72) or obese (adjusted OR, 2.04; 95% CI, 1.39 to 2.98) were also strongly associated with SARS-CoV-2 positivity.
Even in an integrated healthcare system, Asian or Pacific Islander patients were less likely to undergo SARS-CoV-2 testing than White survivors, but more likely to test positive. Additionally, Latinx ethnicity and high body mass index were strongly correlated with a greater odds of SARS-CoV-2 test positivity.
由于大流行期间的健康不平等现象加剧，我们评估了在一个大型乳腺癌幸存者队列中，SARS-CoV-2 检测的使用情况是否因种族或民族而异，并检查了检测呈阳性的相关因素。
我们对 2020 年参加加利福尼亚州一个大型综合医疗保健计划的 22481 名成年乳腺癌幸存者进行了回顾性队列研究。我们收集了他们的乳腺癌诊断、合并症和人口统计学特征的数据。我们根据种族或民族、合并症和其他患者特征检查了 2020 年 3 月至 2020 年 9 月期间的 SARS-CoV-2 检测使用情况。我们还检查了 SARS-CoV-2 检测呈阳性的相关因素。我们进行了双变量和多变量逻辑回归，以确定检测使用和检测阳性的相关性。
在这 22481 名女性中，有 3288 名（14.6%）接受了 SARS-CoV-2 检测。该队列包括 51.8%的有色人种女性。在接受检测的 3288 名女性中，有 264 名（8.0%）检测结果呈阳性。在多变量分析中，拉丁裔幸存者进行检测的可能性（调整后的优势比[OR]，1.23；95%CI，1.12 至 1.34）高于白人幸存者；然而，亚洲或太平洋岛民幸存者的检测率低 16%（调整后的 OR，0.84；95%CI，0.75 至 0.94）。与白人幸存者相比，拉丁裔幸存者的检测阳性率高 3.5 倍（调整后的 OR，3.47；95%CI，2.52 至 4.77），亚洲或太平洋岛民或其他种族幸存者的检测阳性率高 2.2 倍（调整后的 OR，2.23；95%CI，1.49 至 3.34）。超重（调整后的 OR，1.83；95%CI，1.24 至 2.72）或肥胖（调整后的 OR，2.04；95%CI，1.39 至 2.98）也与 SARS-CoV-2 阳性密切相关。
即使在一个综合医疗保健系统中，亚洲或太平洋岛民患者接受 SARS-CoV-2 检测的可能性也低于白人幸存者，但检测呈阳性的可能性更高。此外，拉丁裔族群和较高的体重指数与 SARS-CoV-2 检测阳性的可能性更大呈强烈相关。
