Association of Race and Ethnicity with COVID-19 Test Positivity and Hospitalization Is Mediated by Socioeconomic Factors

Abstract

Rationale: Black race and Hispanic ethnicity are associated with increased risks for coronavirus disease (COVID-19) infection and severity. It is purported that socioeconomic factors may drive this association, but data supporting this assertion are sparse. Objectives: To evaluate whether socioeconomic factors mediate the association of race/ethnicity with COVID-19 incidence and outcomes. Methods: We conducted a retrospective cohort study of adults tested for (cohort 1) or hospitalized with (cohort 2) COVID-19 between March 1, 2020, and July 23, 2020, at the University of Miami Hospital and Clinics. Our primary exposure was race/ethnicity. We considered socioeconomic factors as potential mediators of our exposure’s association with outcomes. We used standard statistics to describe our cohorts and multivariable regression modeling to identify associations of race/ethnicity with our primary outcomes, one for each cohort, of test positivity (cohort 1) and hospital mortality (cohort 2). We performed a mediation analysis to see whether household income, population density, and household size mediated the association of race/ethnicity with outcomes. Results: Our cohorts included 15,473 patients tested (29.0% non-Hispanic White, 48.1% Hispanic White, 15.0% non-Hispanic Black, 1.7% Hispanic Black, and 1.6% other) and 295 patients hospitalized (9.2% non-Hispanic White, 56.9% Hispanic White, 21.4% non-Hispanic Black, 2.4% Hispanic Black, and 10.2% other). Among those tested, 1,256 patients (8.1%) tested positive, and, of the hospitalized patients, 47 (15.9%) died. After adjustment for demographics, race/ethnicity was associated with test positivity—odds-ratio (95% confidence interval [CI]) versus non-Hispanic White for Non-Hispanic Black: 3.21 (2.60–3.96), Hispanic White: 2.72 (2.28–3.26), and Hispanic Black: 3.55 (2.33–5.28). Population density mediated this association (percentage mediated, 17%; 95% CI, 11–31%), as did median income (27%; 95% CI, 18–52%) and household size (20%; 95% CI, 12–45%). There was no association between race/ethnicity and mortality, although this analysis was underpowered. Conclusions: Black race and Hispanic ethnicity are associated with an increased odds of COVID-19 positivity. This association is substantially mediated by socioeconomic factors.

Spatial variation in the joint effect of extreme heat events and ozone on respiratory hospitalizations in California

“…In the context of our findings, it means that if we were able to (hypothetically) reduce income inequalities between race/ethnic groups (at the neighborhood level) to zero, observed race/ethnic disparities regarding the joint impacts of extreme heat and ozone would disappear. Interestingly, such patterns have been found in other studies in environmental epidemiology (67) or in the context of COVID-19 test positivity and risk of hospitalization (69).…”

Association of Healthcare Access With Intensive Care Unit Utilization and Mortality in Patients of Hispanic Ethnicity Hospitalized With COVID‐19

“…While some studies reported a higher mortality rate for Hispanic patients, [11][12][13][14][15] others showed no difference. 4,16,17 A recent meta-analysis found that intensive care unit (ICU) utilization and mortality were slightly higher among Hispanic COVID-19 inpatients, but this finding did not reach statistical significance. 18 Past studies from different healthcare systems were limited by the small sample size of hospitalized Hispanic patients and the heterogeneity of patients.…”

COVID-19 and race/color disparity: a brief analysis of the indigenous population in a state in the Brazilian Amazon

“…(2) In the United States, an expressive unequal relation has also been described among American Indians and Alaska Natives, when compared with the non-Hispanic white population. (3) Although there are studies on the vulnerability of minority groups, (2,4) few studies on COVID-19 have been conducted exclusively among Brazilian indigenous. Therefore, we used data from the State Department of Health of Amapá (5) and from the Brazilian Institute of Geography and Statistics Automatic Retrieval System, (6) to perform an ecological analysis of the occurrence of COVID-19 in the indigenous and non-indigenous population of Amapá (1°16'50.1"N 51°52'58.6"W).…”

“…This discrepancy in COVID-19 infection between indigenous and nonindigenous people in Amapá is possibly due to the susceptibility of indigenous people to SARS-CoV-2, which may be mediated by socioeconomic, sociodemographic, and/or genetic factors. (2)(3)(4) Thus, ethnic minorities in contexts of low social development, as is the situation of much of the population of Amapá, may have a greater chance of infection, as well as of developing more severe cases of COVID-19. (4,7) In Amapá, approximately 20% of indigenous people live in urban areas (https://indigenas.ibge.gov.…”