Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio.
Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio.
PLoS One. 2021 Aug 5;16(8):e0255343. doi: 10.1371/journal.pone.0255343. eCollection 2021.
Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood.
To characterize socioeconomic and chronic disease-related mechanisms underlying these differences.
Observational cohort study.
Outpatient and emergency care.
12900 Cleveland Clinic Health System patients referred for SARS-CoV-2 testing between March 17 and April 15, 2020.
Nasopharyngeal PCR test for SARS-CoV-2 infection.
Test location (emergency department, ED, vs. outpatient care), COVID-19 symptoms, test positivity and hospitalization among positive cases.
We identified six classes of symptoms, ranging in test positivity from 3.4% to 23%. Non-Hispanic Black race/ethnicity was disproportionately represented in the group with highest positivity rates. Non-Hispanic Black patients ranged from 1.81 [95% confidence interval: 0.91-3.59] times (at age 20) to 2.37 [1.54-3.65] times (at age 80) more likely to test positive for the SARS-CoV-2 virus than non-Hispanic White patients, while test positivity was not significantly different across the neighborhood income spectrum. Testing in the emergency department (OR: 5.4 [3.9, 7.5]) and cardiovascular disease (OR: 2.5 [1.7, 3.8]) were related to increased risk of hospitalization among the 1247 patients who tested positive.
Constraints on availability of test kits forced providers to selectively test for SARS-Cov-2.
Non-Hispanic Black patients and patients from low-income neighborhoods tended toward more severe and prolonged symptom profiles and increased comorbidity burden. These factors were associated with higher rates of testing in the ED. Non-Hispanic Black patients also had higher test positivity rates.
已记录到 SARS-CoV-2 大流行早期筛查和结果存在社会和生态差异，但尚不清楚这些差异产生的原因。
描述导致这些差异的社会经济和慢性疾病相关机制。
观察性队列研究。
门诊和急诊护理。
2020 年 3 月 17 日至 4 月 15 日期间，克利夫兰诊所医疗系统的 12900 名患者被推荐进行 SARS-CoV-2 检测。
用于 SARS-CoV-2 感染的鼻咽 PCR 检测。
检测位置（急诊室与门诊护理）、COVID-19 症状、阳性病例的检测阳性率和住院率。
我们确定了六种症状类别，其检测阳性率从 3.4%到 23%不等。非西班牙裔黑人在检测阳性率最高的群体中所占比例不成比例。非西班牙裔黑人患者从 20 岁时的 1.81 倍（95%置信区间：0.91-3.59）到 80 岁时的 2.37 倍（1.54-3.65），感染 SARS-CoV-2 病毒的可能性是同年龄段非西班牙裔白人患者的 1.81 倍到 2.37 倍，而非西班牙裔黑人患者在不同的邻里收入范围内，检测阳性率没有显著差异。在 1247 名检测呈阳性的患者中，在急诊室进行检测（比值比：5.4[3.9，7.5]）和患有心血管疾病（比值比：2.5[1.7，3.8]）与住院风险增加相关。
检测试剂盒的供应限制迫使医务人员有选择地进行 SARS-CoV-2 检测。
非西班牙裔黑人患者和来自低收入社区的患者往往症状更严重且持续时间更长，合并症负担增加。这些因素与在急诊室进行更多检测相关。非西班牙裔黑人患者的检测阳性率也更高。
