Widening the gap: greater racial and ethnic disparities in COVID-19 burden after accounting for missing race/ethnicity data

Labgold, Katie; Hamid, Sarah; Shah, Sarita; Gandhi, Neel R; Chamberlain, Allison T.; Khan, Fazle; Khan, Shamimul; Smith, Sasha; Williams, Steve; Lash, Timothy L.; Collin, Lindsay J.

doi:10.1101/2020.09.30.20203315

Cited by 43 publications

(47 citation statements)

References 9 publications

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“…Considering our findings substantiate reports of increased COVID-19 burden among ethnic minority groups in other countries, it is concerning that information on ethnicity is often not collected in routine surveillance systems in many countries(29). This results in these important differences in disease burden being concealed within the data, hindering the ability to set up targeted initiatives to reach particularly vulnerable populations.…”

Section: Discussionsupporting

confidence: 86%

Hospitalisation rates differed by city district and ethnicity during the first wave of COVID-19 in Amsterdam, the Netherlands

Coyer

Wynberg

Buster

et al. 2021

Preprint

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Background It is important to gain insight into the burden of COVID-19 at city district level to develop targeted prevention strategies. We examined COVID-19 related hospitalisations by city district and migration background in the municipality of Amsterdam, the Netherlands. Methods We used surveillance data on all PCR-confirmed SARS-CoV-2 hospitalisations in Amsterdam until 31 May 2020, matched to municipal registration data on migration background. We calculated directly standardised (age, sex) rates (DSR) of hospitalisations, as a proxy of COVID-19 burden, per 100,000 population by city district and migration background. We calculated standardised rate differences (RD) and rate ratios (RR) to compare hospitalisations between city districts of varying socio-economic and health status and between migration backgrounds. We evaluated the effects of city district and migration background on hospitalisation after adjusting for age and sex using Poisson regression. Results Between 29 February and 31 May 2020, 2326 cases (median age 57 years [IQR=37-74]) were notified in Amsterdam, of which 596 (25.6%) hospitalisations and 287 (12.3%) deaths. 526/596 (88.2%) hospitalisations could be matched to the registration database. DSR were higher in individuals living in peripheral (South-East/New-West/North) city districts with lower economic and health status, compared to central districts (Centre/West/South/East) (RD=36.87,95%CI=25.79-47.96;RR=1.82,95%CI=1.65-1.99), and among individuals with a non-Western migration background compared to ethnic-Dutch individuals (RD=57.05,95%CI=43.34-70.75; RR=2.36,95%CI=2.17-2.54). City district and migration background were independently associated with hospitalisation. Conclusion City districts with lower economic and health status and those with a non-Western migration background had the highest burden of COVID-19 during the first wave of COVID-19 in Amsterdam.

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Section: Discussionsupporting

confidence: 86%

Hospitalisation rates differed by city district and ethnicity during the first wave of COVID-19 in Amsterdam, the Netherlands

Coyer

Wynberg

Buster

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…The limitations of this study include the use of administrative data and self-reported racial designations; approximately 22% of patients in our study belonged to an unknown racial category, which may limit our ability to draw inferences [ 9 , 10 ]. Further, our documentation of telehealth early in the pandemic was unable to distinguish telephonic and video visits, which may vary across racial and age groups [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Telehealth Use by Age and Race at a Single Academic Medical Center During the COVID-19 Pandemic: Retrospective Cohort Study

Stevens¹,

Mechanic²,

Markson³

et al. 2021

J Med Internet Res

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Background During the COVID-19 pandemic, many ambulatory clinics transitioned to telehealth, but it remains unknown how this may have exacerbated inequitable access to care. Objective Given the potential barriers faced by different populations, we investigated whether telehealth use is consistent and equitable across age, race, and gender. Methods Our retrospective cohort study of outpatient visits was conducted between March 2 and June 10, 2020, compared with the same time period in 2019, at a single academic health center in Boston, Massachusetts. Visits were divided into in-person visits and telehealth visits and then compared by racial designation, gender, and age. Results At our academic medical center, using a retrospective cohort analysis of ambulatory care delivered between March 2 and June 10, 2020, we found that over half (57.6%) of all visits were telehealth visits, and both Black and White patients accessed telehealth more than Asian patients. Conclusions Our findings indicate that the rapid implementation of telehealth does not follow prior patterns of health care disparities.

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“…Complicating the evaluations of these disparities is the reliance on medical record reporting of race/ethnicity. A recent epidemiological analysis estimates that due to inherent biases of medical record documentation and missing data, complete case analyses are likely underestimating the magnitude of the racial and ethnic disparities seen in most reporting thus far, and at a minimum suggest using quantitative bias analysis methods that account for unequal and non-random missingness [ 84 ].…”

Section: Sars-cov2 Infection In Special Pediatric Nephrology Populationsmentioning

confidence: 99%

Kidney implications of SARS-CoV2 infection in children

et al. 2021

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Research indicates that severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection can impact every organ, and the effects can range from asymptomatic to severe disease. Since it was first discovered in December 2019, our understanding has grown about its impact on kidney disease. In general, children have less severe disease than adults, and this tendency appears to extend to special pediatric kidney populations (e.g., chronic kidney disease and immunosuppressed patients with solid organ transplants or nephrotic syndrome). However, in a fraction of infected children, SARS-CoV2 causes an array of kidney manifestations, ranging from acute kidney injury to thrombotic microangiopathy, with potential implications for increased risk of morbidity and mortality. Additional considerations surround the propensity for clotting extracorporeal circuits in children with SARS-CoV2 infection that are receiving kidney replacement therapy. This review provides an update on our current understanding of SARS-CoV2 for pediatric nephrologists and highlights knowledge gaps to be addressed by future research during this ongoing pandemic, particularly the social disparities magnified during this period.

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Widening the gap: greater racial and ethnic disparities in COVID-19 burden after accounting for missing race/ethnicity data

Cited by 43 publications

References 9 publications

Hospitalisation rates differed by city district and ethnicity during the first wave of COVID-19 in Amsterdam, the Netherlands

Hospitalisation rates differed by city district and ethnicity during the first wave of COVID-19 in Amsterdam, the Netherlands

Telehealth Use by Age and Race at a Single Academic Medical Center During the COVID-19 Pandemic: Retrospective Cohort Study

Kidney implications of SARS-CoV2 infection in children

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