Differences in COVID-19-Related Testing and Healthcare Utilization by Race and Ethnicity in the Veterans Health Administration

Abstract

Importance Recent reports indicate differences in COVID-19-related care and outcomes between Black and White Americans. Objective We examine the COVID-19-related healthcare utilization and mortality by race and ethnicity of patients tested for SARS-CoV-2 in the Veterans Health Administration (VHA). Design A retrospective cohort study. Setting We used the VHA COVID-19 shared data resources between February 1 and June 30, 2020. Participants Veterans tested for SARS-CoV-2 virus by VHA. Exposure(s) Three racial-ethnicity groups of Black, Hispanic, and White (as reference) veterans. Main Outcome(s) and Measure(s) Main outcomes are testing rate, positivity rate, hospitalization rate, ICU admission rate, and in-hospital mortality. Controlling for sex, age, and Elixhauser comorbidity index, we report adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) from logistic regression models. Results Of the 8,667,996 active veteran enrollees, 252,702 were tested by VHA from February to June, 2020, with 20,500 positive results and 4,790 hospitalizations. The testing rate was 4.4% among Black and 4.7% among Hispanic veterans compared to White veterans, 2.8%. The testing positivity rate was similarly elevated among Black (12.2%) and Hispanic (11.6%) veterans compared to White veterans (6.0%). The aORs of hospitalization in Black veterans (1.88; 95% CI 1.74, 2.03) and Hispanic veterans (1.41; 95% CI 1.25, 1.60) were higher compared to White veterans. No significant differences by race and ethnicity were observed in OR or aOR of ICU admission and in-hospital death among hospitalized patients. Conclusions and Relevance On a national level, the VHA was more likely to test and hospitalize Black and Hispanic veterans compared to White veterans, but there were no significant differences in ICU admission or in-hospital mortality among those hospitalized. This pattern of differences may relate to social determinants of health, factors affecting access to non-VHA care, or preferences for VHA care affecting initial care seeking, but not in-hospital outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-00982-0.

Increased COVID-19 Infection Risk Drives Racial and Ethnic Disparities in Severe COVID-19 Outcomes

“…Escobar et al found that Asian American, BA/AA, and HI/LA individuals (in Kaiser Permanente Northern California) had higher odds of COVID-19 infection compared to non-HI/LA White individuals, but that there were no differences across racial and ethnic groups in mortality among hospitalized patients [26]. A retrospective study conducted in the US Department of Veterans Affairs by Razjouyan et al found higher testing positivity rates and increased risk of hospitalization due to COVID-19 among BA/AA and HI/LA veterans, but also found that among those hospitalized there were no differences across race and ethnic groups in intensive care utilization or death [27]. Khanna et al found, in the population of patients served by the University of Maryland family medicine and immediate care, BA/AA patients and HI/LA patients were more likely to experience COVID-19 infection than non-HI/LA White patients [28].…”

Disparities in Wait Times for Care Among US Veterans by Race and Ethnicity

“…First, as we expected, overall wait times increased substantially during the COVID-19 period. This finding is consistent with other studies 15 , 23 , 41 , 42 , 43 and is not surprising, given that substantial numbers of US residents delayed or went without care, particularly early in the pandemic.…”

Inflammatory Biomarkers Differ among Hospitalized Veterans Infected with Alpha, Delta, and Omicron SARS-CoV-2 Variants

“…Our team, as well as others, showed that mortality and poor clinical outcomes in COVID-19 are linked to the presence of comorbid conditions as assessed by Charlson Comorbidity Index [ 11 , 31 ]. Our data shows that prior to or after adjustment for comorbid conditions using CCI; mortality remains significantly lower in Omicron compared to the two other study variants.…”

“…This is a retrospective cohort study that includes all Veterans who tested positive for SARS-CoV-2 between 1 February 2020 and 7 July 2022 and were hospitalized related to COVID-19 infection. The inclusion criteria were the first positive test and hospital admission within 7 days after the SARS-CoV-2 test date or within 15 days prior to the test date [ 10 , 11 , 12 ]. The exclusion criteria were not being veterans and not being an active VHA healthcare user.…”