Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States.
International Medical University, School of Pharmacy, Department of Pharmacy Practice, Kuala Lumpur, Malaysia.
Front Public Health. 2023 Sep 7;11:1206988. doi: 10.3389/fpubh.2023.1206988. eCollection 2023.
Meta-analyses have investigated associations between race and ethnicity and COVID-19 outcomes. However, there is uncertainty about these associations' existence, magnitude, and level of evidence. We, therefore, aimed to synthesize, quantify, and grade the strength of evidence of race and ethnicity and COVID-19 outcomes in the US.
In this umbrella review, we searched four databases (Pubmed, Embase, the Cochrane Database of Systematic Reviews, and Epistemonikos) from database inception to April 2022. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR-2). The strength of evidence of the associations between race and ethnicity with outcomes was ranked according to established criteria as convincing, highly suggestive, suggestive, weak, or non-significant. The study protocol was registered with PROSPERO, CRD42022336805.
Of 880 records screened, we selected seven meta-analyses for evidence synthesis, with 42 associations examined. Overall, 10 of 42 associations were statistically significant ( ≤ 0.05). Two associations were highly suggestive, two were suggestive, and two were weak, whereas the remaining 32 associations were non-significant. The risk of COVID-19 infection was higher in Black individuals compared to White individuals (risk ratio, 2.08, 95% Confidence Interval (CI), 1.60-2.71), which was supported by highly suggestive evidence; with the conservative estimates from the sensitivity analyses, this association remained suggestive. Among those infected with COVID-19, Hispanic individuals had a higher risk of COVID-19 hospitalization than non-Hispanic White individuals (odds ratio, 2.08, 95% CI, 1.60-2.70) with highly suggestive evidence which remained after sensitivity analyses.
Individuals of Black and Hispanic groups had a higher risk of COVID-19 infection and hospitalization compared to their White counterparts. These associations of race and ethnicity and COVID-19 outcomes existed more obviously in the pre-hospitalization stage. More consideration should be given in this stage for addressing health inequity.
荟萃分析已经研究了种族和民族与 COVID-19 结局之间的关联。然而，这些关联的存在、程度和证据水平仍存在不确定性。因此，我们旨在综合、量化和评估美国种族和民族与 COVID-19 结局之间的证据强度。
在本次伞式综述中，我们从数据库创建之初到 2022 年 4 月，在四个数据库（PubMed、Embase、Cochrane 系统评价数据库和 Epistemonikos）中进行了搜索。使用评估多个系统评价（AMSTAR-2）评估了每个荟萃分析的方法学质量。根据既定标准，将种族和民族与结局之间关联的证据强度评为令人信服、高度提示、提示、弱或无显著性。研究方案已在 PROSPERO、CRD42022336805 上注册。
在筛选出的 880 条记录中，我们选择了 7 项荟萃分析进行证据综合，共检查了 42 项关联。总体而言，42 项关联中有 10 项具有统计学意义（≤0.05）。其中 2 项关联具有高度提示性，2 项关联具有提示性，2 项关联具有弱提示性，而其余 32 项关联无显著性。与白人个体相比，黑人个体感染 COVID-19 的风险更高（风险比，2.08；95%置信区间（CI），1.60-2.71），这一关联具有高度提示性证据；敏感性分析中的保守估计表明，这一关联仍然具有提示性。在感染 COVID-19 的个体中，与非西班牙裔白人个体相比，西班牙裔个体 COVID-19 住院的风险更高（比值比，2.08；95%CI，1.60-2.70），具有高度提示性证据，敏感性分析后仍然存在。
与白人个体相比，黑人和西班牙裔个体感染 COVID-19 和住院的风险更高。种族和民族与 COVID-19 结局之间的这些关联在住院前阶段更为明显。在这个阶段，应该更加关注解决健康不平等问题。
