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Rationale:
Black race and Hispanic ethnicity are associated with increased risks for COVID-19 infection and severity. It is purported that socioeconomic factors may drive this association, but data supporting this assertion are sparse.
Objective:
To evaluate whether socioeconomic factors mediate the association of race/ethnicity with COVID-19 in...
Contexts in source publication
Context 1
... two study cohorts consisted of 15,473 patients tested (cohort 1) and 295 patients hospitalized (cohort 2) for COVID-19 ( Figure E1). Patients excluded due to missing data from cohort 1 tended to be younger and more commonly commercially insured than those remaining in the cohort; those excluded from cohort 2 were more frequently men (Table E1). The race/ethnic distribution of patients tested for COVID-19 was similar to that historically admitted to UMHC, but included more Non-Hispanic White (29.0% ...Context 2
... race/ethnic distribution of patients tested for COVID-19 was similar to that historically admitted to UMHC, but included more Non-Hispanic White (29.0% vs 13.0%) and fewer Hispanic White (48.1% vs 62.0%) people than the general Miami-Dade County population (Table 1). Patients tested for COVID-19 also tended to be younger (32.6% vs 23.9% less than 50 years-old) and more commonly insured by Commercial payors (53.4% vs 33.7%) than the historic UMHC population. ...Context 3
... addition of socioeconomic factors did not change these findings. Moreover, our sensitivity analyses on an expanded cohort without adjustment for SOFA score, with imputed SOFA score, and with fewer covariables also demonstrated no association between race/ethnicity and mortality (Tables E9, E10, and E11). Similarly, no association was found between race/ethnicity and ventilator usage (Table E12) or disposition to a facility for survivors (Table E13). ...Context 4
... our sensitivity analyses on an expanded cohort without adjustment for SOFA score, with imputed SOFA score, and with fewer covariables also demonstrated no association between race/ethnicity and mortality (Tables E9, E10, and E11). Similarly, no association was found between race/ethnicity and ventilator usage (Table E12) or disposition to a facility for survivors (Table E13). As race/ethnicity was not significantly associated with outcomes in hospitalized COVID-19 positive patients, mediation analyses were not conducted. ...Context 5
... our sensitivity analyses on an expanded cohort without adjustment for SOFA score, with imputed SOFA score, and with fewer covariables also demonstrated no association between race/ethnicity and mortality (Tables E9, E10, and E11). Similarly, no association was found between race/ethnicity and ventilator usage (Table E12) or disposition to a facility for survivors (Table E13). As race/ethnicity was not significantly associated with outcomes in hospitalized COVID-19 positive patients, mediation analyses were not conducted. ...Similar publications
Background
The ongoing Coronavirus disease of 2019 (COVID-19) pandemic has hit Brazil hard in period of different dominant variants. Different COIVD-19 variants have swept through the region, resulting that the total number of cases in Brazil is the third highest in the world. This study is aimed at investigating the regional heterogeneity of in-ho...
Objective:
To identify differences in short-term outcomes of patients with coronavirus disease 2019 (COVID-19) according to various racial/ethnic groups.
Design:
Analysis of Cerner de-identified COVID-19 dataset.
Setting:
A total of 62 health care facilities.
Participants:
The cohort included 49,277 adult COVID-19 patients who were hospitali...
Citations
... The findings of this systematic review on PA's associations with ethnicity extend current knowledge on the relationship between ethnicity and health: Previous research showed that biological, cultural, and socioeconomic factors that differ across ethnic groups underlie health disparities. Factors such as income, education, health-related behaviors, language barriers and literacy account for a substantial portion of the racial-ethnic differences in health [6,8,[44][45][46][47]. Nevertheless, it is important to note that a racial gap in health was suggested to persist in every level of socioeconomic status [6,7]. ...
... Data has shown similar disparities nationally (2). Studies have shown that this is due, in part, to systemic racism and inequities leading to differences in comorbidities, access to health care, and occupation (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). For example, BIPOC persons are more likely to be employed in front-line work, leading to more exposure, and decreasing the effectiveness of mitigation strategies like shelter-in-place for these groups (22)(23)(24)(25)(26). ...
Marginalized racial and ethnic groups in the United States were disproportionally affected by the COVID-19 pandemic. To study these disparities, we construct an age-and-race-stratified mathematical model of SARS-CoV-2 transmission fitted to age-and-race-stratified data from 2020 in Oregon and analyze counterfactual vaccination strategies in early 2021. We consider two racial groups: non-Hispanic White persons and persons belonging to BIPOC groups (including non-Hispanic Black persons, non-Hispanic Asian persons, non-Hispanic American-Indian or Alaska-Native persons, and Hispanic or Latino persons). We allocate a limited amount of vaccine to minimize overall disease burden (deaths or years of life lost), inequity in disease outcomes between racial groups (measured with five different metrics), or both. We find that, when allocating small amounts of vaccine (10% coverage), there is a trade-off between minimizing disease burden and minimizing inequity. Older age groups, who are at a greater risk of severe disease and death, are prioritized when minimizing measures of disease burden, and younger BIPOC groups, who face the most inequities, are prioritized when minimizing measures of inequity. The allocation strategies that minimize combinations of measures can produce middle-ground solutions that similarly improve both disease burden and inequity, but the trade-off can only be mitigated by increasing the vaccine supply. With enough resources to vaccinate 20% of the population the trade-off lessens, and with 30% coverage, we can optimize both equity and mortality. Our goal is to provide a race-conscious framework to quantify and minimize inequity that can be used for future pandemics and other public health interventions.
... Thus, isolation is simply more difficult from a practical standpoint among this population. A third possible reason for these disparities is that individuals from ethnic minority groups are more likely to work in occupations in essential industries in which they are in close proximity to others, thus, increasing their risk of exposure to COVID-19 (30,36). Fourth, there may be language barriers that present challenges to the public health messaging regarding COVID-19 prevention (31,(37)(38)(39). ...
... When we examined COVID-19 outcomes conditional on being COVID-19 infected, we found that racial and ethnic groups also experienced a higher risk of hospitalization. One potential reason is that minorities have a higher burden of chronic health conditions, including diabetes, heart disease, and lung disease which can contribute to poor COVID-19 outcomes (32,36,41). Additionally, ethnic minority individuals are more likely to be uninsured (42), limiting their access to treatment services when infected (43). ...
Background
Meta-analyses have investigated associations between race and ethnicity and COVID-19 outcomes. However, there is uncertainty about these associations’ existence, magnitude, and level of evidence. We, therefore, aimed to synthesize, quantify, and grade the strength of evidence of race and ethnicity and COVID-19 outcomes in the US.
Methods
In this umbrella review, we searched four databases (Pubmed, Embase, the Cochrane Database of Systematic Reviews, and Epistemonikos) from database inception to April 2022. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR-2). The strength of evidence of the associations between race and ethnicity with outcomes was ranked according to established criteria as convincing, highly suggestive, suggestive, weak, or non-significant. The study protocol was registered with PROSPERO, CRD42022336805.
Results
Of 880 records screened, we selected seven meta-analyses for evidence synthesis, with 42 associations examined. Overall, 10 of 42 associations were statistically significant (p ≤ 0.05). Two associations were highly suggestive, two were suggestive, and two were weak, whereas the remaining 32 associations were non-significant. The risk of COVID-19 infection was higher in Black individuals compared to White individuals (risk ratio, 2.08, 95% Confidence Interval (CI), 1.60–2.71), which was supported by highly suggestive evidence; with the conservative estimates from the sensitivity analyses, this association remained suggestive. Among those infected with COVID-19, Hispanic individuals had a higher risk of COVID-19 hospitalization than non-Hispanic White individuals (odds ratio, 2.08, 95% CI, 1.60–2.70) with highly suggestive evidence which remained after sensitivity analyses.
Conclusion
Individuals of Black and Hispanic groups had a higher risk of COVID-19 infection and hospitalization compared to their White counterparts. These associations of race and ethnicity and COVID-19 outcomes existed more obviously in the pre-hospitalization stage. More consideration should be given in this stage for addressing health inequity.
... It has been argued that migrants could be at higher risk of exposure to the virus due to adverse social and living environments 1,2,14 . Indeed, studies have shown that socioeconomic status and living conditions can at least partially account for the disparities in COVID-19 morbidity and mortality by country of birth 1,2,9,11,15 . In later waves, studies have recorded lower vaccination uptake among migrants 16 . ...
Migrants have been more affected by the COVID-19 pandemic. Whether this has varied over the course of the pandemic remains unknown. We examined how inequalities in intensive care unit (ICU) admission and death related to COVID-19 by country of birth have evolved over the course of the pandemic, while considering the contribution of social conditions and vaccination uptake. A population-based cohort study was conducted including adults living in Sweden between March 1, 2020 and June 1, 2022 (n = 7,870,441). Poisson regressions found that migrants from Africa, Middle East, Asia and European countries without EU28/EEA, UK and Switzerland had higher risk of COVID-19 mortality and ICU admission than Swedish-born. High risks of COVID-19 ICU admission was also found in migrants from South America. Inequalities were generally reduced through subsequent waves of the pandemic. In many migrant groups socioeconomic status and living conditions contributed to the disparities while vaccination campaigns were decisive when such became available.
... Furthermore, the COVID-19 burden is unevenly distributed: marginalized populations such as non-Italians and refugees have been impaired by a higher COVID-19 incidence and mortality rate [7]. In western countries, ethnic disparities played a dramatic role during the pandemic: ethnic minorities faced an excess of risks of testing positive for SARS-CoV-2, hospitalization, and adverse COVID-19 health outcomes compared with the White population [8][9][10][11][12][13][14][15][16]. ...
... These findings are consistent with published literature regarding the role of ethnicity in COVID-19 outcomes. Several studies have demonstrated a high rate of test positivity among Hispanic people [9,13,39]. A qualitative study describing the experiences of Latinx individuals with COVID-19 reported little use of preventive measures because COVID-19 was perceived as a distant and secondary threat. ...
Background:
There is evidence that non-Italians presented higher incidence of infection and worse health outcomes if compared to native populations in the COVID-19 pandemic. The aim of the study was to compare Italian- and non-Italian-born health outcomes, accounting for socio-economic levels.
Methods:
We analyzed data relative to 906,463 people in Umbria (Italy) from 21 February 2020 to 31 May 2021. We considered the National Deprivation Index, the Urban-Rural Municipalities Index and the Human Development Index (HDI) of the country of birth. We used a multilevel logistic regression model to explore the influence of these factors on SARS-CoV-2 infection and hospitalization rates. Diagnosis in the 48 h preceding admission was an indicator of late diagnosis among hospitalized cases.
Results:
Overall, 54,448 persons tested positive (6%), and 9.7% of them were hospitalized. The risk of hospital admission was higher among non-Italians and was inversely related to the HDI of the country of birth. A diagnosis within 48 h before hospitalization was more frequent among non-Italians and correlated to the HDI level.
Conclusions:
COVID-19 had unequal health outcomes among the population in Umbria. Reduced access to primary care services in the non-Italian group could explain our findings. Policies on immigrants' access to primary healthcare need to be improved.
... The ethnic minority groups which were reviewed varied considerably between studies, due to the different regions each study was conducted in. Studies from the USA commonly explored Hawaiian/Pacific Island, Hispanic or Latinx communities (30, 31,36,37,41,43) where conversely, studies conducted through Europe, would investigate other European nations or African regions (21,28,46). One study also reviewed the use of non-English language in the family/home and found that the use of non-English language increased infection risk (41). ...
... It is important to better understand the links between different risk factors and the behaviors that drive them so targeted responses and interventions can be designed. This relationship between risk factors was also observed in the most commonly reported risk factors, minority ethnicity or race and country of birth (18,28,30,31,36,37,41,43,46). As previously highlighted, one study found that speaking a language other than English in the household, was an indicator of increased risk of infection (41). ...
Introduction
Identifying SARS-CoV-2 infection risk factors allows targeted public health and social measures (PHSM). As new, more transmissible variants of concern (VoC) emerge, vaccination rates increase and PHSM are eased, it is important to understand any potential change to infection risk factors. The aim of this systematic literature review is to describe the risk factors for SARS-CoV-2 infection by VoC.
Methods
A literature search was performed in MEDLINE, PubMed and Embase databases on 5 May 2022. Eligibility included: observational studies published in English after 1 January 2020; any age group; the outcome of SARS-CoV-2 infection; and any potential risk factors investigated in the study. Results were synthesized into a narrative summary with respect to measures of association, by VoC. ROBINS-E tool was utilized for risk of bias assessment.
Results
Of 6,197 studies retrieved, 43 studies were included after screening. Common risk factors included older age, minority ethnic group, low socioeconomic status, male gender, increased household size, occupation/lower income level, inability to work from home, public transport use, and lower education level. Most studies were undertaken when the ancestral strain was predominant. Many studies had some selection bias due to testing criteria and limited laboratory capacity.
Conclusion
Understanding who is at risk enables the development of strategies that target priority groups at each of the different stages of a pandemic and helps inform vaccination strategies and other interventions which may also inform public health responses to future respiratory infection outbreaks. While it was not possible to determine changes to infection risk by recent VoC in this review, the risk factors identified will add to the overall understanding of the groups who are at greatest risk of infection in the early stages of a respiratory virus outbreak.
Systematic review registration
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022330706, PROSPERO [CRD42022330706].
... demographic factors: residential crowding (6), social vulnerability (1,7), socioeconomic status (1,8), preferred language (9), education level (10), and access to testing (11). Furthermore, the development of novel COVID-19 treatments that require early administration after symptom onset has heightened the importance of understanding disparities in access to testing and care (12)(13)(14)(15). ...
... We identified that preferred language drives the disparity based on race and ethnicity, while social vulnerability, insurance status, and distance to hospital were not in the causal pathway. This contrasts with other work that has demonstrated that social factors may explain up to 27% of racial and ethnic disparities in COVID-19-related test positivity and hospitalization (8). Although a larger study or a study performed in a different context may show different results, our findings nevertheless highlight language as a potential priority target for potential interventions to reduce disparities. ...
Unlabelled:
Which social factors explain racial and ethnic disparities in COVID-19 access to care and outcomes remain unclear.
Objectives:
We hypothesized that preferred language mediates the association between race, ethnicity and delays to care.
Design setting and participants:
Multicenter, retrospective cohort study of adults with COVID-19 consecutively admitted to the ICU in three Massachusetts hospitals in 2020.
Main outcome and measures:
Causal mediation analysis was performed to evaluate potential mediators including preferred language, insurance status, and neighborhood characteristics.
Results:
Non-Hispanic White (NHW) patients (157/442, 36%) were more likely to speak English as their preferred language (78% vs. 13%), were less likely to be un- or under-insured (1% vs. 28%), lived in neighborhoods with lower social vulnerability index (SVI) than patients from racial and ethnic minority groups (SVI percentile 59 [28] vs. 74 [21]) but had more comorbidities (Charlson comorbidity index 4.6 [2.5] vs. 3.0 [2.5]), and were older (70 [13.2] vs. 58 [15.1] years). From symptom onset, NHW patients were admitted 1.67 [0.71-2.63] days earlier than patients from racial and ethnic minority groups (p < 0.01). Non-English preferred language was associated with delay to admission of 1.29 [0.40-2.18] days (p < 0.01). Preferred language mediated 63% of the total effect (p = 0.02) between race, ethnicity and days from symptom onset to hospital admission. Insurance status, social vulnerability, and distance to the hospital were not on the causal pathway between race, ethnicity and delay to admission.
Conclusions and relevance:
Preferred language mediates the association between race, ethnicity and delays to presentation for critically ill patients with COVID-19, although our results are limited by possible collider stratification bias. Effective COVID-19 treatments require early diagnosis, and delays are associated with increased mortality. Further research on the role preferred language plays in racial and ethnic disparities may identify effective solutions for equitable care.
... Ethnic minorities are at high risk of severe illness and death from COVID-19, which may be attributable to prevalent preexisting health issues (e.g., obesity, diabetes), low income, and limited access to health insurance and healthcare (Cione et al., 2020;Moya et al., 2022). Empirical studies suggest that Hispanic individuals experience higher rates of COVID-19 cases, hospitalizations, and deaths (Gershengorn et al., 2021;Gross et al., 2020;Parolin & Lee, 2022). Disproportionate impacts of COVID-19 on Hispanic populations are exacerbating the preexisting socioeconomic vulnerabilities and health disparities (Cione et al., 2020;Moya et al., 2022). ...
Objectives:
We explored the importance of environmental and mobility strategies during early COVID-19 by age and ethnicity and investigated predictors of park visitations considering the COVID-19 impacts.
Background:
Parks are safe and accessible venues to stay active and reduce social isolation, which is especially important considering COVID-19 and the associated lockdowns.
Methods:
We analyzed online survey data from 683 residents (collected July 2020) of El Paso, TX, and objective measures of neighborhood park characteristics. Chi-square tests and mixed-effects logistic regression analyses were performed to examine the environmental/mobility strategies, personal and environmental factors, and park visitations, considering the COVID-19 impacts.
Results:
The percentage of those who visited (1+ times/week) parks or trails/paths in the neighborhood dropped from 41.7% to 19.5% since the start of COVID-19 (OR = 0.015, p < .001). Before COVID-19, middle-aged and older adults were less likely to visit parks than younger adults, while this difference became insignificant during early COVID-19. Hispanic adults were more likely to visit parks than non-Hispanics both before and during early COVID-19. Positive environmental predictors of park visitations included park availability in the neighborhood, proximity to the closest park, seeing people being physically active in the neighborhood, and neighborhood aesthetics.
Conclusions:
Proximately located parks, trails, and paths well integrated into residential communities, and high aesthetic quality of the neighborhood are the potential features of pandemic-resilient communities and should be considered an important national priority to maintain and promote the health and well-being of the population, especially during pandemics like COVID-19.
... A cross-sectional study of 1000 children in the United States who were tested for COVID-19 at the same testing center showed that children of racial or ethnic minorities and children from families with lower incomes had higher COVID-19 positivity rates than non-Hispanic White children and children from families with higher incomes (Goyal et al. 2020). When compared to their White counterparts, Black and Hispanic persons have greater case and mortality rates for COVID-19, as well as more severe clinical consequences, according to the findings of a number of additional research (Gershengorn et al. 2021;Mahajan and Larkins-Pettigrew 2020;Gross et al. 2020). Similarly, in comparison to non-Hispanic White individuals, American Indian and Alaska Native (AIAN) individuals have a 1.7 times greater risk of being infected with COVID-19, a 3.4 times greater risk of being hospitalized, and a 2.4 times greater risk of suffering from COVID-19-associated mortality (Centers for Disease Control and Prevention 2021). ...
... Social determinants of health refer to nonmedical factors that influence the health of individuals and communities (10). Over the COVID-19 pandemic, cases have been more common in racialized (individuals who racially, ethnically, or culturally feel separated from the dominant culture) and socio-economically disadvantaged individuals, as well as in younger people, in many countries (11)(12)(13)(14). Demographic and social determinants of health are used to address health inequity by targeting risk mitigation strategies and by allocating resources to underserved individuals and populations. ...
We compared the seroprevalence of SARS-CoV-2 anti-nucleocapsid antibodies in blood donors across Canadian regions in 2021. The seroprevalence was the highest in Alberta and the Prairies, and it was so low in Atlantic Canada that few correlates were observed. Being male and of young age were predictive of seropositivity. Racialization was associated with higher seroprevalence in British Columbia and Ontario but not in Alberta and the Prairies. Living in a materially deprived neighborhood predicted higher seroprevalence, but it was more linear across quintiles in Alberta and the Prairies, whereas in British Columbia and Ontario, the most affluent 60% were similarly low and the most deprived 40% similarly elevated. Living in a more socially deprived neighborhood (more single individuals and one parent families) was associated with lower seroprevalence in British Columbia and Ontario but not in Alberta and the Prairies. These data show striking variability in SARS-CoV-2 seroprevalence across regions by social determinants of health. IMPORTANCE Canadian blood donors are a healthy adult population that shows clear disparities associated with racialization and material deprivation. This underscores the pervasiveness of the socioeconomic gradient on SARS-CoV-2 infections in Canada. We identify regional differences in the relationship between SARS-CoV-2 seroprevalence and social determinants of health. Cross-Canada studies, such as ours, are rare because health information is under provincial jurisdiction and is not available in sufficient detail in national data sets, whereas other national seroprevalence studies have insufficient sample sizes for regional comparisons. Ours is the largest seroprevalence study in Canada. An important strength of our study is the interpretation input from a public health team that represented multiple Canadian provinces. Our blood donor seroprevalence study has informed Canadian public health policy at national and provincial levels since the start of the SARS-CoV-2 pandemic.
