VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA.
Department of Medicine, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA.
J Racial Ethn Health Disparities. 2022 Apr;9(2):519-526. doi: 10.1007/s40615-021-00982-0. Epub 2021 Mar 10.
Recent reports indicate differences in COVID-19-related care and outcomes between Black and White Americans.
We examine the COVID-19-related healthcare utilization and mortality by race and ethnicity of patients tested for SARS-CoV-2 in the Veterans Health Administration (VHA).
A retrospective cohort study.
We used the VHA COVID-19 shared data resources between February 1 and June 30, 2020.
Veterans tested for SARS-CoV-2 virus by VHA.
EXPOSURE(S): Three racial-ethnicity groups of Black, Hispanic, and White (as reference) veterans.
MAIN OUTCOME(S) AND MEASURE(S): Main outcomes are testing rate, positivity rate, hospitalization rate, ICU admission rate, and in-hospital mortality. Controlling for sex, age, and Elixhauser comorbidity index, we report adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) from logistic regression models.
Of the 8,667,996 active veteran enrollees, 252,702 were tested by VHA from February to June, 2020, with 20,500 positive results and 4,790 hospitalizations. The testing rate was 4.4% among Black and 4.7% among Hispanic veterans compared to White veterans, 2.8%. The testing positivity rate was similarly elevated among Black (12.2%) and Hispanic (11.6%) veterans compared to White veterans (6.0%). The aORs of hospitalization in Black veterans (1.88; 95% CI 1.74, 2.03) and Hispanic veterans (1.41; 95% CI 1.25, 1.60) were higher compared to White veterans. No significant differences by race and ethnicity were observed in OR or aOR of ICU admission and in-hospital death among hospitalized patients.
On a national level, the VHA was more likely to test and hospitalize Black and Hispanic veterans compared to White veterans, but there were no significant differences in ICU admission or in-hospital mortality among those hospitalized. This pattern of differences may relate to social determinants of health, factors affecting access to non-VHA care, or preferences for VHA care affecting initial care seeking, but not in-hospital outcomes.
最近的报告表明，黑人和美国白人在与 COVID-19 相关的护理和结果方面存在差异。
我们研究了退伍军人事务部 (VHA) 检测到的 SARS-CoV-2 患者的种族和民族与 COVID-19 相关的医疗保健利用和死亡率。
回顾性队列研究。
我们使用了 2020 年 2 月 1 日至 6 月 30 日之间的 VHA COVID-19 共享数据资源。
退伍军人通过 VHA 检测 SARS-CoV-2 病毒。
黑、西班牙裔和白（作为参考）三个种族群体的退伍军人。
主要结果是检测率、阳性率、住院率、ICU 入院率和住院死亡率。在控制了性别、年龄和 Elixhauser 合并症指数后，我们报告了来自 logistic 回归模型的调整后比值比 (aOR) 和 95%置信区间 (95%CI)。
在 8667996 名现役退伍军人中，有 252702 名退伍军人在 2020 年 2 月至 6 月期间通过 VHA 接受了检测，其中有 20500 个阳性结果和 4790 例住院治疗。黑人退伍军人的检测率为 4.4%，西班牙裔退伍军人的检测率为 4.7%，而白人退伍军人的检测率为 2.8%。黑人（12.2%）和西班牙裔（11.6%）退伍军人的检测阳性率也明显高于白人退伍军人（6.0%）。黑人退伍军人（1.88；95%CI 1.74，2.03）和西班牙裔退伍军人（1.41；95%CI 1.25，1.60）的住院率的 aOR 高于白人退伍军人。在 ICU 入院和住院死亡率方面，住院患者的种族和民族之间没有观察到 OR 或 aOR 的显著差异。
在全国范围内，VHA 更有可能对黑人退伍军人和西班牙裔退伍军人进行检测和住院治疗，而不是对白人退伍军人进行检测和住院治疗，但在 ICU 入院或住院死亡率方面，住院患者没有显著差异。这种差异模式可能与健康的社会决定因素、影响获得非 VHA 护理的因素或影响最初寻求 VHA 护理的偏好有关，但与住院结果无关。
