Analysis examines racial disparities in COVID-19 infection

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An analysis early in the novel coronavirus (COVID-19) pandemic found racial and ethnic disparities in the likelihood of testing positive for the coronavirus, but no significant disparities in mortality among those who were hospitalized, according to a new study published in the journal Annals of Internal Medicine.

For the study, researchers examined a total of 3.5 million Kaiser Permanente members in Northern California, 2.6 percent of whom, or 91,212 people, received a COVID-19 test between February 1 and May 31, 2020. Of the total, 4 percent, or 3,686, tested positive.

According to the study, Latino patients were nearly four times as likely as white patients to become infected with the virus, while Asian and Black patients were two times as likely to get COVID-19 as white patients. The odds of hospitalization were also higher for Latino, Asian, and Black patients with COVID-19 than for white patients. However, the study did not find racial disparities in mortality among patients hospitalized after infection.

The authors of the study said the findings reinforce the urgent message to health systems to mitigate the spread of COVID-19 in their highest-risk communities by seeking to reduce transmission among the most vulnerable.

The study confirmed other research linking specific comorbidities with increased mortality from COVID-19, and that nonwhite patients were more likely to have chronic health conditions. However, the authors noted that there are complex reasons why that might be.

Unadjusted hospital mortality rates were highest among white patients (17 percent), followed by Black patients (12.7 percent), Asian patients (10.5 percent), and Hispanic patients (9.7 percent). After adjusting for age, severity of illness, and comorbidities, racial and ethnic differences were no longer significantly different.

Along with following the outcomes for those who tested positive, the analysis also looked at the role of geographic location, finding infections clustered in areas with higher proportions of nonwhite members, regardless of their health risks for COVID-19.

The researchers found race was a major factor in likelihood of infection, but contributed in a minor way to hospitalization, admission, and death. For those adverse outcomes, age was the major predictor.

"We need to continue to explore the reasons why some communities have higher infection rates, which in a pandemic can be deadly," said Gabriel Escobar, MD, lead author and an investigator with the Kaiser Permanente Northern California Division of Research, in a statement. "It's also our responsibility as clinicians and healthcare leaders to improve the way we reach out to these communities."

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