Magesh Shruti, John Daniel, Li Wei Tse, Li Yuxiang, Mattingly-App Aidan, Jain Sharad, Chang Eric Y, Ongkeko Weg M
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego.
Research Service, VA San Diego Healthcare System, San Diego, California.
JAMA Netw Open. 2021 Nov 1;4(11):e2134147. doi: 10.1001/jamanetworkopen.2021.34147.
COVID-19 has disproportionately affected racial and ethnic minority groups, and race and ethnicity have been associated with disease severity. However, the association of socioeconomic determinants with racial disparities in COVID-19 outcomes remains unclear.
To evaluate the association of race and ethnicity with COVID-19 outcomes and to examine the association between race, ethnicity, COVID-19 outcomes, and socioeconomic determinants.
A systematic search of PubMed, medRxiv, bioRxiv, Embase, and the World Health Organization COVID-19 databases was performed for studies published from January 1, 2020, to January 6, 2021.
Studies that reported data on associations between race and ethnicity and COVID-19 positivity, disease severity, and socioeconomic status were included and screened by 2 independent reviewers. Studies that did not have a satisfactory quality score were excluded. Overall, less than 1% (0.47%) of initially identified studies met selection criteria.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Associations were assessed using adjusted and unadjusted risk ratios (RRs) and odds ratios (ORs), combined prevalence, and metaregression. Data were pooled using a random-effects model.
The main measures were RRs, ORs, and combined prevalence values.
A total of 4 318 929 patients from 68 studies were included in this meta-analysis. Overall, 370 933 patients (8.6%) were African American, 9082 (0.2%) were American Indian or Alaska Native, 101 793 (2.4%) were Asian American, 851 392 identified as Hispanic/Latino (19.7%), 7417 (0.2%) were Pacific Islander, 1 037 996 (24.0%) were White, and 269 040 (6.2%) identified as multiracial and another race or ethnicity. In age- and sex-adjusted analyses, African American individuals (RR, 3.54; 95% CI, 1.38-9.07; P = .008) and Hispanic individuals (RR, 4.68; 95% CI, 1.28-17.20; P = .02) were the most likely to test positive for COVID-19. Asian American individuals had the highest risk of intensive care unit admission (RR, 1.93; 95% CI, 1.60-2.34, P < .001). The area deprivation index was positively correlated with mortality rates in Asian American and Hispanic individuals (P < .001). Decreased access to clinical care was positively correlated with COVID-19 positivity in Hispanic individuals (P < .001) and African American individuals (P < .001).
In this study, members of racial and ethnic minority groups had higher risks of COVID-19 positivity and disease severity. Furthermore, socioeconomic determinants were strongly associated with COVID-19 outcomes in racial and ethnic minority populations.
新冠病毒病（COVID-19）对种族和少数族裔群体的影响尤为严重，种族和族裔与疾病严重程度相关。然而，社会经济决定因素与COVID-19结果中的种族差异之间的关联仍不明确。
评估种族和族裔与COVID-19结果之间的关联，并研究种族、族裔、COVID-19结果和社会经济决定因素之间的关联。
对PubMed、medRxiv、bioRxiv、Embase和世界卫生组织COVID-19数据库进行系统检索，以查找2020年1月1日至2021年1月6日发表的研究。
纳入报告了种族和族裔与COVID-19阳性、疾病严重程度及社会经济状况之间关联数据的研究，并由2名独立评审员进行筛选。质量评分不令人满意的研究被排除。总体而言，最初确定的研究中不到1%（0.47%）符合入选标准。
遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。使用调整和未调整的风险比（RRs）、比值比（ORs）、合并患病率和Meta回归评估关联。数据采用随机效应模型进行汇总。
主要指标为RRs、ORs和合并患病率值。
本Meta分析共纳入来自68项研究的4318929例患者。总体而言，370933例患者（8.6%）为非裔美国人，9082例（0.2%）为美洲印第安人或阿拉斯加原住民，101793例（2.4%）为亚裔美国人，851392例被认定为西班牙裔/拉丁裔（19.7%），7417例（0.2%）为太平洋岛民，1037996例（24.0%）为白人，269040例（6.2%）被认定为多种族及其他种族或族裔。在年龄和性别调整分析中，非裔美国人（RR，3.54；95%CI，1.38 - 9.07；P = 0.008）和西班牙裔个体（RR，4.68；95%CI，1.28 - 17.20；P = 0.02）感染COVID-19呈阳性的可能性最高。亚裔美国人入住重症监护病房的风险最高（RR，1.93；95%CI，1.60 - 2.34，P < 0.001）。地区贫困指数与亚裔美国人和西班牙裔个体的死亡率呈正相关（P < 0.001）。获得临床护理的机会减少与西班牙裔个体（P < 0.001）和非裔美国人个体（P < 0.001）的COVID-19阳性呈正相关。
在本研究中，种族和少数族裔群体成员感染COVID-19呈阳性及疾病严重程度的风险更高。此外，社会经济决定因素与种族和少数族裔人群的COVID-19结果密切相关。
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