Disparities in SARS-CoV-2 seroprevalence among individuals presenting for care in central North Carolina over a six-month period

Abstract

Background Robust community-level SARS-CoV-2 prevalence estimates have been difficult to obtain in the American South and outside of major metropolitan areas. Furthermore, though some previous studies have investigated the association of demographic factors such as race with SARS-CoV-2 exposure risk, fewer have correlated exposure risk to surrogates for socioeconomic status such as health insurance coverage. Methods We used a highly specific serological assay utilizing the receptor binding domain of the SARS-CoV-2 spike-protein to identify SARS-CoV-2 antibodies in remnant blood samples collected by the University of North Carolina Health system. We estimated the prevalence of SARS-CoV-2 in this cohort with Bayesian regression, as well as the association of critical demographic factors with higher prevalence odds. Findings Between April 21st and October 3rd of 2020, a total of 9,624 unique samples were collected from clinical sites in central NC and we observed a seroprevalence increase from 2.9 (1.7, 4.3) to 9.1 (7.2, 11.1) over the study period. Individuals who identified as Latinx were associated with the highest odds ratio of SARS-CoV-2 exposure at 7.77 overall (5.20, 12.10). Increased odds were also observed among Black individuals and individuals without public or private health insurance. Interpretation Our data suggests that for this care-accessing cohort, SARS-CoV-2 seroprevalence was significantly higher than cumulative total cases reported for the study geographical area six months into the COVID-19 pandemic in North Carolina. The increased odds of seropositivity by ethnoracial grouping as well as health insurance highlights the urgent and ongoing need to address underlying health and social disparities in these populations.

Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in the United States: Living Density, Viral Load, and Disproportionate Impact on Communities of Color

“…To our knowledge, this is the first study to show increased transmission in non-White US households. Though they experience similar case fatality rates, African American/Black and Hispanic populations in the United States experience disproportionately higher rates of SARS-CoV-2 infection [19][20][21]. These racial disparities are likely due to differences in healthcare access and exposure risk that are driven by systemic societal inequities rather than individual biological or behavioral characteristics [22][23][24][25].…”

SARS-CoV-2 seroprevalence and risk factors among meat packing, produce processing, and farm workers

“…Whole blood ELISA titers of 1:20, 1:40, and 1:120 were compared to plasma-based ELISA OD readings using confirmed SARS-CoV-2 antibody negative and positive controls. The sensitivity and specificity of the 1:20 titer were previously obtained [18]. We calculated the sensitivity and specificity of the 1:40 and 1:120 titers (S1 Table ).…”

SARS-CoV-2 Seroprevalence and Drug Use in Trauma Patients from Six Sites in the United States

“…Currently, there are over 200 million confirmed cases of COVID-19 globally, with the United States accounting for almost 18 % of these cases 1 . The U.S. prevalence and disparities of SARS-CoV-2 infection have been documented in different demographics and regional areas [2][3][4][5][6][7] . However, this statistic undercounts pre-symptomatic and asymptomatic patients, both of whom can transmit SARS-CoV-2 8 ; hence, the number of people spreading SARS-CoV-2 at any given time is difficult to determine.…”