Cho Wendy K Tam, Hwang David G
Department of Ophthalmology, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
Department of Political Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
J Racial Ethn Health Disparities. 2023 Aug;10(4):1653-1668. doi: 10.1007/s40615-022-01351-1. Epub 2022 Jul 19.
The COVID-19 pandemic has uncovered clinically meaningful racial/ethnic disparities in COVID-19-related health outcomes. Current understanding of the basis for such an observation remains incomplete, with both biomedical and social/contextual variables proposed as potential factors.
Using a logistic regression model, we examined the relative contributions of race/ethnicity, biomedical, and socioeconomic factors to COVID-19 test positivity and hospitalization rates in a large academic health care system in the San Francisco Bay Area prior to the advent of vaccination and other pharmaceutical interventions for COVID-19.
Whereas socioeconomic factors, particularly those contributing to increased social vulnerability, were associated with test positivity for COVID-19, biomedical factors and disease co-morbidities were the major factors associated with increased risk of COVID-19 hospitalization. Hispanic individuals had a higher rate of COVID-19 positivity, while Asian persons had higher rates of COVID-19 hospitalization. The excess hospitalization risk attributed to Asian race was not explained by differences in the examined biomedical or sociodemographic variables. Diabetes was an important risk factor for COVID-19 hospitalization, particularly among Asian patients, for whom diabetes tended to be more frequently undiagnosed and higher in severity.
We observed that biomedical, racial/ethnic, and socioeconomic factors all contributed in varying but distinct ways to COVID-19 test positivity and hospitalization rates in a large, multi-racial, socioeconomically diverse metropolitan area of the United States. The impact of a number of these factors differed according to race/ethnicity. Improving overall COVID-19 health outcomes and addressing racial and ethnic disparities in COVID-19 outcomes will likely require a comprehensive approach that incorporates strategies that target both individual-specific and group contextual factors.
新冠疫情揭示了新冠相关健康结果中具有临床意义的种族/族裔差异。目前对于这一观察结果的基础认识仍不完整，生物医学和社会/环境变量均被认为是潜在因素。
我们使用逻辑回归模型，在新冠疫苗接种及其他药物干预措施出现之前，研究了种族/族裔、生物医学和社会经济因素对旧金山湾区一个大型学术医疗系统中新冠病毒检测阳性率和住院率的相对贡献。
社会经济因素，尤其是那些导致社会脆弱性增加的因素，与新冠病毒检测阳性相关，而生物医学因素和疾病共病是与新冠住院风险增加相关的主要因素。西班牙裔个体的新冠病毒阳性率较高，而亚裔个体的新冠住院率较高。在所研究的生物医学或社会人口统计学变量差异中，并未解释亚裔种族导致的额外住院风险。糖尿病是新冠住院的一个重要风险因素，尤其是在亚裔患者中，他们的糖尿病往往更常未被诊断且病情更严重。
我们观察到，在美国一个大型、多种族、社会经济多样化的大都市地区，生物医学、种族/族裔和社会经济因素都以不同但独特的方式对新冠病毒检测阳性率和住院率产生影响。其中一些因素的影响因种族/族裔而异。改善整体新冠健康结果并解决新冠结果中的种族和族裔差异，可能需要一种综合方法，该方法应纳入针对个体特定因素和群体环境因素的策略。
