ObjectivesTo identify sociodemographic, clinical and behavioural drivers of racial disparities and their association with clinical outcomes among Kaiser Permanente Georgia (KPGA) members with COVID-19.DesignRetrospective cohort of patients with COVID-19 seen from 3 March to 29 October 2020. We described the distribution of underlying comorbidities, quality of care metrics, demographic and social determinants of health (SDOH) indicators across race groups. We also described clinical outcomes in hospitalised patients including length of stay, intensive care unit (ICU) admission, readmission and mortality. We performed multivariable analyses for hospitalisation risk among all patients with COVID-19 and stratifyied by race and sex.SettingKPGA, an integrated healthcare system.Participants5712 patients who all had laboratory-confirmed COVID-19. Of them, 57.8% were female, 58.4% black, 29.5% white, 8.5% Hispanic and 3.6% Asian.ResultsBlack patients had the highest proportions of living in neighborhoods under the federal poverty line (12.4%) and in more deprived locations (neighbourhood deprivation index=0.4). Overall, 14.4% (n=827) of this cohort was hospitalised. Asian patients had the highest rates of ICU admission (53.1%) and mechanical ventilation (21.9%). Among all patients, Hispanics (adjusted 1.60, 95% CI (1.08, 2.37)), blacks (1.43 (1.13, 1.83)), age in years (1.03 (1.02, 1.04)) and living in a zip code with high unemployment (1.08 (1.03, 1.13)) were associated with higher odds of hospitalisation. COVID-19 patients with chronic obstructive pulmonary disease (2.59 (1.67, 4.02)), chronic heart failure (1.79 (1.31, 2.45)), immunocompromised (1.77 (1.16, 2.70)), with glycated haemoglobin >8% (1.68 (1.19, 2.38)), depression (1.60 (1.24, 2.06)), hypertension (1.5 (1.21, 1.87)) and physical inactivity (1.25 (1.03, 1.51)) had higher odds of hospitalisation.ConclusionsBlack and Hispanic KPGA patients were at higher odds of hospitalisation, but not mortality, compared with other race groups. Beyond previously reported sociodemographics and comorbidities, factors such as quality of care, lifestyle behaviours and SDOH indicators should be considered when designing and implementing interventions to reduce COVID-19 racial disparities.

Introduction: Racial and ethnic minorities have shouldered a disproportioned burden of coronavirus disease 2019 (COVID-19) infection to date in the US, but data on the various drivers of these disparities is limited. Objectives: To describe the characteristics and outcomes of COVID-19 patients and explore factors associated with hospitalization risk by race. Methods: Case series of 448 consecutive patients with confirmed COVID-19 seen at Kaiser Permanente Georgia (KPGA), an integrated health care system serving the Atlanta metropolitan area, from March 3 to May 12, 2020. KPGA members with laboratory-confirmed COVID-19. Multivariable analyses for hospitalization risk also included an additional 3489 persons under investigation (PUI) with suspected infection. COVID-19 treatment and outcomes, underlying comorbidities and quality of care management metrics, socio-demographic and other individual and community-level social determinants of health (SDOH) indicators. Results: Of 448 COVID-19 positive members, 68,3% was non-Hispanic Black (n=306), 18% non-Hispanic White (n=81) and 13,7% Other race (n=61). Median age was 54 [IQR 43-63) years. Overall, 224 patients were hospitalized, median age 60 (50-69) years. Black race was a significant factor in the Confirmed + PUI, female and male models (ORs from 1.98 to 2.19). Obesity was associated with higher hospitalization odds in the confirmed, confirmed + PUI, Black and male models (ORs from 1.78 to 2.77). Chronic disease control metrics (diabetes, hypertension, hyperlipidemia) were associated with lower odds of hospitalization ranging from 48% to 35% in the confirmed + PUI and Black models. Self-reported physical inactivity was associated with 50% higher hospitalization odds in the Black and Female models. Residence in the Northeast region of Atlanta was associated with lower hospitalization odds in the Confirmed + PUI, White and female models (ORs from 0.22 to 0.64) Conclusions: We found that non-Hispanic Black KPGA members had a disproportionately higher risk of infection and, after adjusting for covariates, twice the risk of hospitalization compared to other race groups. We found no significant differences in clinical outcomes or mortality across race/ethnicity groups. In addition to age, sex and comorbidity burden, pre-pandemic self-reported exercise, metrics on quality of care and control of underlying cardio-metabolic diseases, and location of residence in Atlanta were significantly associated with hospitalization risk by race groups. Beyond well-known physiologic and clinical factors, individual and community-level social indicators and health behaviors must be considered as interventions designed to reduce COVID-19 disparities and the systemic effects of racism are implemented.

Purpose: Social influences on health are inadequately understood, hindering progress in eliminating disparities in cancer. One such influence, social isolation, is well established as an independent risk factor for mortality and comparable in magnitude to other risks such as obesity. Social isolation is associated with smoking, which is increasingly concentrated in socioeconomically disadvantaged (SED) populations. However, the association between social isolation and smoking is understudied. This study examined the extent to which psychosocial, life-contextual, and health care factors account for the social isolation-smoking relationship among SED adults. Methods: The study used data from a cross-sectional survey of SED adults (N=3064) recruited from an information and referral program that helps individuals with meeting basic needs (e.g., food). Measures included current smoking status, social isolation, psychosocial factors (stress, loneliness), life-contextual factors (unmet basic needs), health care factors (time since last routine checkup, health self-efficacy), and demographics. A social isolation score was derived using a modified version of the Social Network Index. Bivariate analyses and multivariable logistic regression examined the association between social isolation and smoking. Path analyses estimated indirect associations between social isolation and smoking via psychosocial, life-contextual, and health care factors while controlling for demographics. Path analyses used full information maximum likelihood with robust estimation and the theta parameterization. Model fit was assessed using the comparative fit index (CFI ≥0.95) and root mean square error of approximation (RMSEA <0.06). Analyses were conducted using SAS and Mplus. Results: The sample was predominantly female (81%), non-Hispanic Black (79%), and highly SED, with 44% having a high school education or less and 52% having an annual household income less than $10,000. Overall, 29% of participants were current smokers, and 62% were highly socially isolated. Social isolation was associated with smoking, with only 10% of the least isolated individuals smoking currently compared to 39% of the most socially isolated individuals (p<0.0001). In analyses adjusting for demographics, odds of being a current smoker increased as social isolation increased (aORs=1.8 to 3.2; p<0.0001). The final path model (RMSEA=0.031 with 90% CI: 0.025, 0.038; CFI=0.970) confirmed a direct path from social isolation to smoking (β=0.14, p<0.0001) and indirect pathways operating through psychosocial, life-contextual, and health care factors (all β≤0.44, all p<0.05). Conclusions: Findings elucidate possible mechanisms driving the social isolation-smoking relationship in SED populations, suggesting several potential intervention approaches for reducing cancer disparities. Evidence-based interventions that consider psychosocial and life-contextual issues may be especially salubrious for SED populations. This abstract is also being presented as Poster A090. Citation Format: Kassandra I. Alcaraz, Rhyan N. Vereen, Antonika Souder, Alan Bienvenida. Contextualizing the association between social isolation and smoking among socioeconomically disadvantaged adults: Psychosocial, life-contextual, and health care factors [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR02.