Kaiser Permanente Mid-Atlantic Permanente Medical Group, Mid-Atlantic Permanente Research Institute, Rockville, Maryland, United States of America.
United Health Group, Fredrick, Maryland, United States of America.
PLoS One. 2022 Nov 23;17(11):e0276742. doi: 10.1371/journal.pone.0276742. eCollection 2022.
Racial/ethnic disparities during the first six months of the COVID-19 pandemic led to differences in COVID-19 testing and adverse outcomes. We examine differences in testing and adverse outcomes by race/ethnicity and sex across a geographically diverse and system-based COVID-19 cohort collaboration.
Observational study among adults (≥18 years) within six US cohorts from March 1, 2020 to August 31, 2020 using data from electronic health record and patient reporting. Race/ethnicity and sex as risk factors were primary exposures, with health system type (integrated health system, academic health system, or interval cohort) as secondary. Proportions measured SARS-CoV-2 testing and positivity; attributed hospitalization and death related to COVID-19. Relative risk ratios (RR) with 95% confidence intervals quantified associations between exposures and main outcomes.
5,958,908 patients were included. Hispanic patients had the highest proportions of SARS-CoV-2 testing (16%) and positivity (18%), while Asian/Pacific Islander patients had the lowest portions tested (11%) and White patients had the lowest positivity rates (5%). Men had a lower likelihood of testing (RR = 0.90 [0.89-0.90]) and a higher positivity risk (RR = 1.16 [1.14-1.18]) compared to women. Black patients were more likely to have COVID-19-related hospitalizations (RR = 1.36 [1.28-1.44]) and death (RR = 1.17 [1.03-1.32]) compared with White patients. Men were more likely to be hospitalized (RR = 1.30 [1.16-1.22]) or die (RR = 1.70 [1.53-1.89]) compared to women. These racial/ethnic and sex differences were reflected in both health system types.
This study supports evidence of disparities by race/ethnicity and sex during the COVID-19 pandemic that persisted even in healthcare settings with reduced barriers to accessing care. Further research is needed to understand and prevent the drivers that resulted in higher burdens of morbidity among certain Black patients and men.
在 COVID-19 大流行的前六个月，种族/民族差异导致 COVID-19 检测和不良结果存在差异。我们通过在地理上多样化和基于系统的 COVID-19 队列合作中，检查了种族/民族和性别之间的检测和不良结果的差异。
这是一项观察性研究，纳入了 2020 年 3 月 1 日至 2020 年 8 月 31 日期间来自美国六个队列的成年患者（≥18 岁），使用电子健康记录和患者报告的数据。种族/民族和性别是主要暴露因素，健康系统类型（综合健康系统、学术健康系统或间隔队列）是次要因素。比例衡量了 SARS-CoV-2 的检测和阳性率；归因于 COVID-19 的住院和死亡。相对风险比（RR）及其 95%置信区间量化了暴露与主要结局之间的关联。
共纳入 5958908 例患者。西班牙裔患者的 SARS-CoV-2 检测比例最高（16%）和阳性率最高（18%），而亚裔/太平洋岛民患者的检测比例最低（11%），白人患者的阳性率最低（5%）。与女性相比，男性检测的可能性较低（RR=0.90[0.89-0.90]），阳性风险较高（RR=1.16[1.14-1.18]）。与白人患者相比，黑人患者 COVID-19 相关住院（RR=1.36[1.28-1.44]）和死亡（RR=1.17[1.03-1.32]）的风险更高。与女性相比，男性住院（RR=1.30[1.16-1.22]）或死亡（RR=1.70[1.53-1.89]）的风险更高。这两种种族/民族和性别差异在两种健康系统类型中均有体现。
这项研究支持了 COVID-19 大流行期间种族/民族和性别差异的证据，即使在获得医疗保健服务的障碍减少的环境中，这些差异仍然存在。需要进一步研究以了解和预防导致某些黑人患者和男性发病率负担更高的驱动因素。
