Racial/ethnic disparities in COVID-19 disease burden & mortality among emergency department patients in a safety net health system

Abstract

Background: We sought to examine racial and ethnic disparities in test positivity rate and mortality among emergency department (ED) patients tested for COVID-19 within an integrated public health system in Northern California. Methods: In this retrospective study we analyzed data from patients seen at three EDs and tested for COVID-19 between April 6 through May 4, 2020. The primary outcome was the test positivity rate by race and ethnicity, and the secondary outcome was 30 day in-hospital mortality. We used multivariable logistic regression to examine associations with COVID-19 test positivity. Results: There were 526 patients tested for COVID-19, of whom 95 (18.1%) tested positive. The mean age of patients tested was 54.2 years, 54.7% were male, and 76.1% had at least one medical comorbidity. Black patients accounted for 40.7% of those tested but 16.8% of the positive tests, and Latinx patients accounted for 26.4% of those tested but 58.9% of the positive tests. The test positivity rate among Latinx patients was 40.3% (56/139) compared with 10.1% (39/387) among non-Latinx patients (p < 0.001). Latinx ethnicity was associated with COVID-19 test positivity (adjusted odds ratio 9.6, 95% confidence interval: 3.5-26.0). Mortality among Black patients was higher than non-Black patients (18.7% vs 1.3%, p < 0.001). Conclusion:We report a significant disparity in COVID-19 adjusted test positivity rate and crude mortality rate among Latinx and Black patients, respectively. Results from ED-based testing can identify racial and ethnic disparities in COVID-19 testing, test positivity rates, and mortality associated with COVID-19 infection and can be used by health departments to inform policy.

Viral And Antibody Testing For Coronavirus Disease 2019 (Covid-19): Factors Associated With Positivity In Electronic Health Records From The United States

“…However, Hispanic patients were underrepresented in the Optum population relative to the census population (Table 1). Our findings related to minority populations and sub-optimal health insurance are consistent with prior research demonstrating the importance of societal and economic inequities, differential exposure, access to tests over the course of the pandemic [12, 13, 16, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29].…”

Changes in pediatric trauma during COVID-19 stay-at-home epoch at a tertiary pediatric hospital

“…Although our institutions are a level 1 pediatric trauma center and regional burn center in a large metropolitan area, it is possible that our data does not encompass the true nature of trauma patterns during the pandemic. Children from differing socioeconomic or racial groups may be less likely to present to large hospital systems owing to disproportionate impact of COVID-19 among minorities [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] . Our literature review has found that there is deeply rooted skepticism, especially within the Black and immigrant communities, toward the medical establishment.…”

Demographic and clinical correlates of acute and convalescent SARS-CoV-2 infection among patients of a U.S. emergency department

“…Emergency Departments (EDs) are potentially unique sites for conducting SARS-CoV-2 serosurveillance, providing a ‘window’ into the community. Historically EDs have played a critical role in prior public health epidemics and pandemics, including HIV, hepatitis C, HSV-2 and influenza H1N1 [ [12] , [13] , [14] ], and more recently, in detecting racial/ethnic disparities for COVID-19 [ 15 ].…”