ABSTRACT

Objectives

Early reports from the initial months of the coronavirus pandemic reveal ethnic disparities in coronavirus incidence, severity, and mortality. This study aimed to evaluate the relationship between ethnicity and outcomes of coronavirus positivity and hospitalization.

Design

An observational cohort study using electronic health record (EHR) data from a large community healthcare system in Washington State across the first phase of the pandemic (March 5 – June 7, 2020).

Results

A total of 18,667 patients (65.9% of all tested) with EHR-documented ethnicity were included. Overall, 6.4% of patients tested positive for coronavirus. Among Latinx patients, 18.6% of those tested were positive, compared to only 4.0% of tested White patients. Multivariable logistic regression revealed significantly higher odds of positivity for Latinxs (aOR = 4.96, 95% CI 4.19–5.87), Asians (aOR = 2.33, 95% CI 1.74–3.08), Blacks (aOR = 1.82, 95% CI 1.43–2.31), and members of other ethnic minority groups (aOR = 2.34, 95% CI 1.80–2.95), compared to Whites in models adjusting for relevant confounders. Latinxs had a higher percentage of self-pay insurance (22.2%) compared to other ethnic groups (7.9–15.8%) and, among those who tested positive, were the only ethnic subpopulation with significantly higher odds than Whites to be hospitalized for COVID-19 (aOR = 2.19, 95% CI 1.45–3.33). We observed a positive correlation between infection and the percentage of Latinxs (r = 0.61, 95% CI 0.45–0.74), Blacks (r = 0.51, 95% CI 0.32–0.66), or Asians (r = 0.64, 95% CI 0.49–0.76) in a given zip-code. This correlationwas negative for Whites (r = −0.63, 95% CI −0.75, −0.45).

Conclusions

We present empirical evidence of higher rates of coronavirus positivity among People of Color compared to White people in Washington State. Social determinants of health, such as occupation, housing, healthcare access, and community structure, may contribute to health disparities in the coronavirus pandemic. Targeted capture of these variables in electronic health records is warranted to inform health equity analyses.

中文翻译：

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华盛顿州冠状病毒阳性人群中种族差异的经验证据

摘要

目标

冠状病毒大流行最初几个月的早期报告显示，冠状病毒的发病率，严重程度和死亡率存在种族差异。本研究旨在评估种族与冠状病毒阳性结果和住院之间的关系。

设计

在大流行的第一阶段（2020年3月5日至6月7日），使用华盛顿州一家大型社区医疗保健系统的电子健康记录（EHR）数据进行的观察性队列研究。

结果

包括18,667名EHR记录的种族患者（占所有测试的65.9％）。总体而言，6.4％的患者冠状病毒检测呈阳性。在拉丁裔患者中，接受测试的患者中有18.6％呈阳性，而接受测试的白人患者中只有4.0％。多变量logistic回归显示拉丁裔（aOR = 4.96，95％CI 4.19–5.87），亚洲人（aOR = 2.33，95％CI 1.74–3.08），黑人（aOR = 1.82，95％CI 1.43–2.31）的阳性几率明显更高），以及其他少数族裔成员（aOR = 2.34，95％CI 1.80–2.95），而在针对相关混杂因素进行调整的模型中，与白人相比。与其他族裔（7.9–15.8％）相比，拉丁裔的自费保险百分比（22.2％）高，并且在测试阳性的人中，是唯一因COVID-19而住院的种族亚群，其几率明显高于白人（aOR = 2.19，95％CI 1.45–3.33）。我们观察到感染与Latinx百分比之间呈正相关（[R  = 0.61，95％CI 0.45-0.74），黑人（[R  = 0.51，95％CI 0.32-0.66），或亚洲人（[R  = 0.64，95％CI 0.49-0.76）在给定邮递区号。对于白人而言，这种相关性为负（r  = -0.63，95％CI -0.75，-0.45）。

结论

我们提供有经验的证据，与华盛顿州的白人相比，有色人种中冠状病毒阳性率更高。健康的社会决定因素，例如职业，住房，医疗保健条件以及社区结构，可能导致冠状病毒大流行中的健康差异。保证在电子健康记录中有针对性地捕获这些变量可为健康资产分析提供信息。