Center for Outcomes Research, Houston Methodist, Josie Roberts Administration Building, 7550 Greenbriar Drive, Suite 4.123, Houston, TX, 77030, USA.
Department of Clinical Medicine, Houston Methodist, Houston, TX, USA.
BMC Public Health. 2021 Jul 6;21(1):1330. doi: 10.1186/s12889-021-11431-2.
BACKGROUND: Disparate racial/ethnic burdens of the Coronavirus Disease 2019 (COVID-19) pandemic may be attributable to higher susceptibility to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or to factors such as differences in hospitalization and care provision. METHODS: In our cross-sectional analysis of lab-confirmed COVID-19 cases from a tertiary, eight-hospital healthcare system across greater Houston, multivariable logistic regression models were fitted to evaluate hospitalization and mortality odds for non-Hispanic Blacks (NHBs) vs. non-Hispanic Whites (NHWs) and Hispanics vs. non-Hispanics. RESULTS: Between March 3rd and July 18th, 2020, 70,496 individuals were tested for SARS-CoV-2; 12,084 (17.1%) tested positive, of whom 3536 (29.3%) were hospitalized. Among positive cases, NHBs and Hispanics were significantly younger than NHWs and Hispanics, respectively (mean age NHBs vs. NHWs: 46.0 vs. 51.7 years; p < 0.001 and Hispanic vs. non-Hispanic: 44.0 vs. 48.7 years; p < 0.001). Despite younger age, NHBs (vs. NHWs) had a higher prevalence of diabetes (25.2% vs. 17.6%; p < 0.001), hypertension (47.7% vs. 43.1%; p < 0.001), and chronic kidney disease (5.0% vs. 3.3%; p = 0.001). Both minority groups resided in lower median income (median income [USD]; NHBs vs. NHWs: 63,489 vs. 75,793; p < 0.001, Hispanic vs. non-Hispanic: 59,104 vs. 68,318; p < 0.001) and higher population density areas (median population density [per square mile]; NHBs vs. NHWs: 3257 vs. 2742; p < 0.001, Hispanic vs. non-Hispanic: 3381 vs. 2884; p < 0.001). In fully adjusted models, NHBs (vs. NHWs) and Hispanics (vs. non-Hispanic) had higher likelihoods of hospitalization, aOR (95% CI): 1.42 (1.24-1.63) and 1.61 (1.46-1.78), respectively. No differences were observed in intensive care unit (ICU) utilization or treatment parameters. Models adjusted for demographics, vital signs, laboratory parameters, hospital complications, and ICU admission vital signs demonstrated non-significantly lower likelihoods of in-hospital mortality among NHBs and Hispanic patients, aOR (95% CI): 0.65 (0.40-1.03) and 0.89 (0.59-1.31), respectively. CONCLUSIONS: Our data did not demonstrate racial and ethnic differences in care provision and hospital outcomes. Higher susceptibility of racial and ethnic minorities to SARS-CoV-2 and subsequent hospitalization may be driven primarily by social determinants.
背景：2019 年冠状病毒病（COVID-19）大流行在不同种族/族裔群体中的负担差异可能归因于对严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）的更高易感性，或归因于住院和护理提供等方面的差异。
方法：在我们对休斯顿大地区八家医院三级医疗保健系统中经实验室确诊的 COVID-19 病例进行的横断面分析中，使用多变量逻辑回归模型评估非西班牙裔黑人（NHB）与非西班牙裔白人（NHW）以及西班牙裔与非西班牙裔之间的住院和死亡几率。
结果：在 2020 年 3 月 3 日至 7 月 18 日期间，对 70496 人进行了 SARS-CoV-2 检测；12084 人（17.1%）检测呈阳性，其中 3536 人（29.3%）住院。在阳性病例中，NHB 和西班牙裔的年龄明显小于 NHW 和西班牙裔，分别为（NHB 与 NHW 相比：46.0 与 51.7 岁；p<0.001 和西班牙裔与非西班牙裔相比：44.0 与 48.7 岁；p<0.001）。尽管年龄较小，但 NHB（与 NHW 相比）的糖尿病患病率更高（25.2%与 17.6%；p<0.001），高血压患病率更高（47.7%与 43.1%；p<0.001），慢性肾脏病患病率更高（5.0%与 3.3%；p=0.001）。两个少数群体的中位收入都较低（中位收入[美元]；NHB 与 NHW：63489 与 75793；p<0.001，西班牙裔与非西班牙裔：59104 与 68318；p<0.001），人口密度更高（中位人口密度[每平方英里]；NHB 与 NHW：3257 与 2742；p<0.001，西班牙裔与非西班牙裔：3381 与 2884；p<0.001）。在完全调整的模型中，NHB（与 NHW 相比）和西班牙裔（与非西班牙裔相比）的住院可能性更高，比值比（95%置信区间）：1.42（1.24-1.63）和 1.61（1.46-1.78）。在 ICU 利用或治疗参数方面没有差异。在调整人口统计学、生命体征、实验室参数、医院并发症和 ICU 入院生命体征的模型中，NHB 和西班牙裔患者的住院死亡率显著降低，比值比（95%置信区间）：0.65（0.40-1.03）和 0.89（0.59-1.31）。
结论：我们的数据并未显示护理提供和医院结局方面存在种族和民族差异。少数族裔对 SARS-CoV-2 的更高易感性以及随后的住院治疗可能主要由社会决定因素驱动。
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