Epidemiology of COVID-19 vs. Influenza: Differential Failure of COVID-19 Mitigation among Hispanics

Abstract

BACKGROUND: During the early phases of the COVID-19 pandemic, predominantly African-American or Hispanic communities were disproportionately impacted. We sought to better understand the epidemiology of COVID-19 among hospitalized Hispanic patients by comparing individual and census-tract level characteristics of patients diagnosed with COVID-19 to those diagnosed with influenza, another viral infection with respiratory transmission. We evaluated the temporal changes in epidemiology across race-ethnicity related to a shelter-in-place mandate. METHODS: We evaluated patients hospitalized at Cook County Health, the safety-net health system for the Chicago metropolitan area. Among self-identified hospitalized Hispanic patients, we compared those with influenza (2019-2020 influenza season) to COVID-19 infection during March 16, 2020 through May 11, 2020. We used multivariable analysis to identify differences in individual and census-tract level characteristics between the two groups. RESULTS: Relative to non-Hispanic blacks and whites, COVID-19 rapidly increased among Hispanics during promotion of social-distancing policies. Whereas non-Hispanic blacks were more likely to be hospitalized for influenza, Hispanic patients predominated among COVID-19 infections (40% relative increase compared to influenza). In the comparative analysis of influenza and COVID-19, Hispanic patients with COVID-19 were more likely to reside in census tracts with higher proportions of residents with the following characteristics: Hispanic; no high school diploma; non-US citizen; limited English speaking ability; employed in manufacturing or construction; and, overcrowding. By multivariable analysis, Hispanic patients hospitalized with COVID-19 compared to those with influenza were more likely to be male (adjusted OR=1.8; 95% CI 1.1 to 2.9) or obese (aOR=2.5; 95% CI 1.5 to 4.2), and to reside in a census tract with ≥40% of residents without a high-school diploma (aOR=2.5; 95% CI 1.3 to 4.8). CONCLUSIONS: The rapid and disproportionate increase in COVID-19 hospitalizations among Hispanics after the shelter-in-place mandate indicates that public health strategies were inadequate in protecting this population. In particular, those residing in neighborhoods with lower levels of educational attainment.

Not a New Story: Place- and Race-Based Disparities in COVID-19 and Influenza Hospitalizations among Medicaid-Insured Adults in New York City

“…Direct comparison between these studies and Table 4 Comparing trends during a concentrated flu season (October to March) with the full year in 2016 and 2017 in order to rule out the effect of non-influenza-related pneumonia, New York City ours is difficult because most are limited to data early in the pandemic, include different baseline influenza years, and utilize populations with different socioeconomic variation than ours. For example, two studies (from the Veterans Health Administration and Cook County, Illinois) reported even greater racial/ethnic disparities during COVID-19, with higher rates of COVID-19 hospitalizations among Black and Hispanic populations compared with previous influenza seasons [19,21]. This difference may be related to the fact that our sample is relatively homogenous economically compared to other samples.…”

“…While many studies have documented the racial/ethnic disparities in COVID-19 hospitalizations [14], only a handful have directly compared COVID-19 with historical influenza patterns. These studies have largely focused on the clinical complications and outcomes among those hospitalized [15][16][17], though some include patient characteristics as part of their descriptive analysis [18][19][20] or as part of a focused analysis among one ethnic group [21]. Direct comparison between these studies and Table 4 Comparing trends during a concentrated flu season (October to March) with the full year in 2016 and 2017 in order to rule out the effect of non-influenza-related pneumonia, New York City ours is difficult because most are limited to data early in the pandemic, include different baseline influenza years, and utilize populations with different socioeconomic variation than ours.…”