Lo Chun-Han, Nguyen Long H, Drew David A, Warner Erica T, Joshi Amit D, Graham Mark S, Anyane-Yeboa Adjoa, Shebl Fatma M, Astley Christina M, Figueiredo Jane C, Guo Chuan-Guo, Ma Wenjie, Mehta Raaj S, Kwon Sohee, Song Mingyang, Davies Richard, Capdevila Joan, Sudre Carole H, Wolf Jonathan, Cozier Yvette C, Rosenberg Lynn, Wilkens Lynne R, Haiman Christopher A, Marchand Loïc Le, Palmer Julie R, Spector Tim D, Ourselin Sebastien, Steves Claire J, Chan Andrew T
Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA.
Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
EClinicalMedicine. 2021 Aug;38:101029. doi: 10.1016/j.eclinm.2021.101029. Epub 2021 Jul 17.
There is limited prior investigation of the combined influence of personal and community-level socioeconomic factors on racial/ethnic disparities in individual risk of coronavirus disease 2019 (COVID-19).
We performed a cross-sectional analysis nested within a prospective cohort of 2,102,364 participants from March 29, 2020 in the United States (US) and March 24, 2020 in the United Kingdom (UK) through December 02, 2020 via the COVID Symptom Study smartphone application. We examined the contribution of community-level deprivation using the Neighborhood Deprivation Index (NDI) and the Index of Multiple Deprivation (IMD) to observe racial/ethnic disparities in COVID-19 incidence. ClinicalTrials.gov registration: NCT04331509.
Compared with non-Hispanic White participants, the risk for a positive COVID-19 test was increased in the US for non-Hispanic Black (multivariable-adjusted odds ratio [OR], 1.32; 95% confidence interval [CI], 1.18-1.47) and Hispanic participants (OR, 1.42; 95% CI, 1.33-1.52) and in the UK for Black (OR, 1.17; 95% CI, 1.02-1.34), South Asian (OR, 1.39; 95% CI, 1.30-1.49), and Middle Eastern participants (OR, 1.38; 95% CI, 1.18-1.61). This elevated risk was associated with living in more deprived communities according to the NDI/IMD. After accounting for downstream mediators of COVID-19 risk, community-level deprivation still mediated 16.6% and 7.7% of the excess risk in Black compared to White participants in the US and the UK, respectively.
Our results illustrate the critical role of social determinants of health in the disproportionate COVID-19 risk experienced by racial and ethnic minorities.
关于个人和社区层面社会经济因素对2019冠状病毒病（COVID-19）个体风险的种族/族裔差异的综合影响，先前的研究有限。
我们通过COVID症状研究智能手机应用程序，对2020年3月29日在美国和2020年3月24日在英国的2102364名参与者的前瞻性队列进行了嵌套横断面分析，直至2020年12月2日。我们使用邻里剥夺指数（NDI）和多重剥夺指数（IMD）来研究社区层面的剥夺对COVID-19发病率种族/族裔差异的影响。ClinicalTrials.gov注册号：NCT04331509。
与非西班牙裔白人参与者相比，在美国，非西班牙裔黑人（多变量调整比值比[OR]，1.32；95%置信区间[CI]，1.18 - 1.47）和西班牙裔参与者（OR，1.42；95%CI，1.33 - 1.52）的COVID-19检测呈阳性风险增加；在英国，黑人（OR，1.17；95%CI，1.02 - 1.34）、南亚人（OR，1.39；95%CI，1.30 - 1.49）和中东参与者（OR，1.38；95%CI，1.18 - 1.61）的风险增加。根据NDI/IMD，这种风险升高与生活在更贫困的社区有关。在考虑了COVID-19风险的下游中介因素后，在美国和英国，社区层面的剥夺分别仍然介导了黑人与白人参与者相比额外风险的16.6%和7.7%。
我们的结果说明了健康的社会决定因素在种族和族裔少数群体所经历的不成比例的COVID-19风险中的关键作用。
