More than two years into the pandemic, multiple analyses of federal, state and local data show that people of color were, and continue to be, disproportionately impacted by COVID-19. New research from physicians and researchers from the Mid-Atlantic Permanente Research Institute (MAPRI) and the Mid-Atlantic Permanente Medical Group shows these disparities also existed in the early months of the pandemic and were more likely to negatively impact Black and Hispanic men. The study, "Differences in COVID-19 testing and adverse outcomes by race, ethnicity, sex, and health system setting in a large diverse U.S. cohort," was published in PLOS One.
From March 2020 to August 2020,
Black men were at the highest risk of death from COVID-19.
Regardless of ethnicity, men were more likely to be hospitalized or die from COVID-19 compared to women.
Men of any ethnicity were less likely to test for COVID-19, yet were more likely to be positive for COVID-19 when they did test.
The percentage of patients hospitalized for COVID-19 and overall mortality rates from COVID-19 were lower in integrated health systems (ex. Kaiser Permanente) regardless of race or sex.
Understanding the disparities of different populations helps us determine where there are gaps in care. Studies like ours show us that nationwide, medical systems need to be more proactive in ensuring that everyone has access to equitable healthcare, particularly during a worldwide pandemic."
Eric Watson, Study's Co-Author and Director of Research Data Analytics for the Mid-Atlantic Permanente Research Institute
Researchers analyzed the electronic medical records of over five million adult patients across several medical systems throughout the United States from March 2020 to August 2020.
COVID-19 testing and positivity rates
Analyses found Hispanic patients had the highest rates of COVID-19 PCR testing and positivity. Those findings were in line with other reports showing Hispanic patients were over two and a half times more likely to test positive for COVID-19 than their white counterparts.
"Some patients from this population were unable to work from home or social distance during the height of lockdowns," said co-author of the study and infectious diseases physician Michael Horberg, MD. "This could've led to an increased risk of exposure to COVID-19, therefore a higher portion of patients testing positive."
Asian/Pacific Islanders had low rates of COVID-19 PCR testing and low positivity rates. White patients had the lowest overall COVID-19 positivity rates despite having high testing rates. Compared to women, men of any ethnicity were less likely to test for COVID-19 yet were more likely to be positive for COVID-19 when they did test.
A total of 5,724 patients studied were hospitalized due to COVID-19 infection. The study found that Black patients were more likely to be hospitalized from COVID-19 compared to white patients. Regardless of ethnicity, men were hospitalized for COVID-19 more frequently than women. The authors said many factors could have driven severe outcomes for Black patients and men during this timeframe.
"We know that, in general, men are less likely to seek care when they are sick," Watson explained. "Delaying care for COVID-19 could lead to more severe outcomes."
Nearly 1,400 patients studied died after being hospitalized with COVID-19. Black men experienced the highest rates of death, closely followed by Hispanic men.
The importance of greater access to care
Researchers noted that patients who received care within integrated health systems like Kaiser Permanente were less likely to experience severe outcomes from COVID-19 compared to academic health systems. The percentage of patients hospitalized for COVID-19 and overall mortality rates from COVID-19 were lower in integrated health systems regardless of race or sex.
"Our model of care makes it easier for patients to prevent and treat illnesses" Watson explained. "Our patients have a team of doctors guiding them throughout their health journey. If they are sick, their care team can quickly and seamlessly point them in the right direction to get proper care. Not all health systems can do that."
Dr. Horberg said that while integrated health systems had improved outcomes, there are still health disparities present. He hopes future research can identify how to better close gaps in care.
"While access to care is important, it represents the end of the disparity pathway, not the beginning," Dr. Horberg said. "We need to better understand how individual, household and structural differences among certain populations may be driving forces for disparities in testing and outcomes related to COVID-19."
Physicians and research scientists from the Mid-Atlantic Permanente Research Institute are currently involved in a variety of studies regarding long COVID, formally known as post-acute sequelae of SARS CoV-2 infection (PASC). This research will also analyze health disparities related to vaccination status.
"If someone is vaccinated against COVID-19, they are less likely to experience symptoms of PASC," Watson said. "So, if we find that there is a disparity in those who received the vaccine, there could potentially a disparity in who experienced more severe acute symptoms or symptoms of PASC."
Jefferson, C., et al. (2022) Differences in COVID-19 testing and adverse outcomes by race, ethnicity, sex, and health system setting in a large diverse U.S. cohort. PLOS ONE. doi.org/10.1371/journal.pone.0276742.