A systematic review of racial/ethnic and socioeconomic disparities in COVID-19

Abstract

Background Preliminary evidence from the COVID-19 pandemic shows the presence of health disparities, especially in terms of morbidity and mortality. This study aimed to systematically review the evidence on the association of racial/ethnic and socioeconomic status (SES) with health outcomes and access to healthcare services during the COVID-19 pandemic. Methods We retrieved published evidence from late December 2019 through March 1, 2021. The target population was the population of the countries during the COVID-19 pandemic. The exposures were defined as belonging to racial/ethnic minority groups and/or low SES. The primary outcomes of interest include (1) death from COVID-19, (2) COVID-19 incidence/infection, (3) COVID-19 hospitalization, (4) ICU admission, (5) need for mechanical ventilation, (6) confirmed diagnosis, and (7) access to testing. We systematically synthesized the findings from different studies and provided a narrative explanation of the results. Results After removing the duplicate results and screening for relevant titles and abstracts, 77 studies were selected for full-text review. Finally, 52 studies were included in the review. The majority of the studies were from the United States (37 studies). Despite the significant incongruity among the studies, most of them showed that racial/ethnic minority groups had higher risks of COVID-19 infection and hospitalization, confirmed diagnosis, and death. Additionally, most of the studies cited factors such as low level of education, poverty, poor housing conditions, low household income, speaking in a language other than the national language in a country, and living in overcrowded households as risk factors of COVID-19 incidence/infection, death, and confirmed diagnosis. However, findings in terms of the association of lack of health insurance coverage and unemployment with the outcome measures as well as the association of requiring mechanical ventilation, ICU admission, and access to testing for COVID-19 with race/ethnicity were limited and inconsistent. Conclusion It is evident that racial/ethnic minority groups and those from low SES are more vulnerable to COVID-19; therefore, public health policymakers, practitioners, and clinicians should be aware of these inequalities and strive to narrow the gap by focusing on vulnerable populations. This systematic review also revealed a major incongruity in the definition of the racial/ethnic minority groups and SES among the studies. Systematic review registration PROSPERO CRD42020190105.

Effect of diabetes on short-term mortality and incidence of first hospitalizations for cardiovascular events after recovery from SARS-CoV-2 infection

“…The increase in mortality risk was as twice as high, in COVID-19+ subjects who recovered from viral infection, when compared with those without any prior documented exposure to SARS-CoV-2. This excess risk of mortality was, as expected, related to co-variates such as aging, lower socio-economic status, presence of co-morbidities or to male sex [1] , [18] , [19] . It is noteworthy to stress that a higher deprivation index is related with an about 20-25% increase in mortality risk: this could be due to the higher risk exposure to COVID-19 in lower socio-economic strata of the population [20] .…”

Differential Effects of Race/Ethnicity and Social Vulnerability on COVID-19 Positivity, Hospitalization, and Death in the San Francisco Bay Area

“…Accordingly, US communities characterized by both high racial and ethnic diversity as well as high socioeconomic diversity are of particular interest for examining the differential contributions of race and ethnicity and socioeconomic factors to health disparities. As a novel, widespread, and contemporaneous disease entity with discrete onset, the COVID-19 pandemic provides a unique and invaluable opportunity to study racial inequities in health care delivery and outcomes in the US [5].…”

Disparities in Level of Care and Outcomes Among Patients with COVID-19: Associations Between Race/Ethnicity, Social Determinants of Health and Virtual Hospitalization, Inpatient Hospitalization, Intensive Care, and Mortality

“…Several studies, including a systematic review examining differences in COVID-19 outcomes by race/ethnicity, have found a similar pattern in disparities, in which Black or Hispanic patients face higher hospitalization and mortality rates. [ 20 , 22 – 25 ] Yet other studies have reported no racial/ethnic differences in case-fatality mortality rates. [ 20 , 26 , 27 ] Despite these differences in findings related to mortality, the literature has consistently shown increased risk of severe illness in racial/ethnic minority populations.…”

“…[ 20 , 26 , 27 ] Despite these differences in findings related to mortality, the literature has consistently shown increased risk of severe illness in racial/ethnic minority populations. [ 25 ] In our study sample, Black and Hispanic patients were more likely to be enrolled in VOU compared to being discharged home without additional care. This suggests that even among those cared for in outpatient settings, there was higher disease severity (based on care level) compared to White patients.…”