Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA, USA.
Department of Family & Community Medicine, UCSF, San Francisco, CA, USA.
Ethn Health. 2023 Aug;28(6):836-852. doi: 10.1080/13557858.2023.2179021. Epub 2023 Mar 12.
To determine whether inequities in COVID-19 infection and hospitalization differ from those for common medical conditions: influenza, appendicitis, and all-cause hospitalization.
Retrospective study based on electronic health records of three healthcare systems in San Francisco (university, public, and community) examining (1) racial/ethnic distribution in cases and hospitalization among patients with diagnosed COVID-19 (March-August 2020) and patients with diagnosed influenza, diagnosed appendicitis, or all-cause hospitalization (August 2017-March 2020), and (2) sociodemographic predictors of hospitalization among those with diagnosed COVID-19 and influenza.
Patients 18 years or older with diagnosed COVID-19 ( = 3934), diagnosed influenza ( = 5932), diagnosed appendicitis ( = 1235), or all-cause hospitalization ( = 62,707) were included in the study. The age-adjusted racial/ethnic distribution of patients with diagnosed COVID-19 differed from that of patients with diagnosed influenza or appendicitis for all healthcare systems, as did hospitalization from these conditions compared to any cause. For example, in the public healthcare system, 68% of patients with diagnosed COVID-19 were Latine, compared with 43% of patients with diagnosed influenza, and 48% of patients with diagnosed appendicitis ( < 0.05). In multivariable logistic regressions, COVID-19 hospitalizations were associated with male sex, Asian and Pacific Islander race/ethnicity, Spanish language, and public insurance in the university healthcare system, and Latine race/ethnicity and obesity in the community healthcare system. Influenza hospitalizations were associated with Asian and Pacific Islander and other race/ethnicity in the university healthcare system, obesity in the community healthcare system, and Chinese language and public insurance in both the university and community healthcare systems.
Racial/ethnic and sociodemographic inequities in diagnosed COVID-19 and hospitalization differed from those for diagnosed influenza and other medical conditions, with consistently higher odds among Latine and Spanish-speaking patients. This work highlights the need for disease-specific public health efforts in at-risk communities in addition to structural upstream interventions.
确定 COVID-19 感染和住院治疗的不公平现象是否与流感、阑尾炎和全因住院等常见医疗状况不同。
基于旧金山三所医疗保健系统（大学、公共和社区）的电子健康记录，进行回顾性研究，考察（1）在 2020 年 3 月至 8 月期间确诊 COVID-19（3934 例）和 2017 年 8 月至 2020 年 3 月期间确诊流感（5932 例）、阑尾炎（1235 例）或全因住院治疗（62707 例）患者中，种族/民族分布情况和住院治疗情况；（2）在确诊 COVID-19 和流感患者中，社会人口预测因素对住院治疗的影响。
本研究纳入了年龄在 18 岁及以上的确诊 COVID-19（ = 3934）、确诊流感（ = 5932）、确诊阑尾炎（ = 1235）或全因住院治疗（ = 62707）患者。在所有医疗系统中，确诊 COVID-19 患者的年龄调整后种族/民族分布与确诊流感或阑尾炎患者不同，与这些疾病相比，COVID-19 患者的住院治疗率也更高。例如，在公共医疗系统中，68%的 COVID-19 患者为拉丁裔，而流感患者为 43%，阑尾炎患者为 48%（ < 0.05）。在多变量逻辑回归分析中，大学医疗系统中 COVID-19 住院治疗与男性、亚裔和太平洋岛民种族/民族、西班牙语和公共保险相关，而社区医疗系统中 COVID-19 住院治疗与拉丁裔种族/民族和肥胖相关。在大学医疗系统中，流感住院治疗与亚裔和太平洋岛民以及其他种族/民族相关，在社区医疗系统中与肥胖相关，在大学和社区医疗系统中都与中文和公共保险相关。
确诊 COVID-19 和住院治疗的种族/民族和社会人口不公平现象与确诊流感和其他医疗状况不同，拉丁裔和讲西班牙语的患者始终具有更高的发病风险。这项工作强调了在高危社区除了采取结构性的上游干预措施外，还需要针对特定疾病开展公共卫生工作。
