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Racial and Ethnic Disparities in SARS-CoV-2 Pandemic: Analysis of a COVID-19 Observational Registry for a Diverse U.S. Metropolitan Population

Our take —

This was a cross sectional study available as a preprint and thus not yet peer reviewed, that identified African-American race, Hispanic ethnicity, older age, and male sex as factors for elevated risk for infection. Higher likelihood of living in a densely populated area appeared to partially explain the elevated risk of infection among African-Americans. Typically, it may not be appropriate to conduct a mediation analysis on a cross-sectional study given ambiguity of the timing of variables; however, it seems appropriate in this analysis as race precedes or is concurrent most other variables (e.g. income level, residential setting, etc.). Further work should explore how racial and income segregation metrics can further explain racial disparities in the COVID-19 pandemic.

Study design

Cross-Sectional

Study population and setting

Investigators gathered data from March 5, 2020, for a 5-week period from the Houston COVID-19 Surveillance and Outcomes Registry (CURATOR). The CURATOR is hosted by the Houston Methodist Hospital System (HM) and contains automatically populated data concerning electronic medical records and SARS-CoV-2 testing. The study contains data from 4,513 individuals tested for SARS-CoV-2 who were tested in clinical settings within the HM due to being symptomatic or self-reporting potential SARS-CoV-2 exposure from traveling to other countries or areas in the US with high transmission. Researchers aimed to identify risk factors for infection as well as mediators between race and elevated SARS-CoV-2 risk.

Summary of Main Findings

Among those tested, the case positivity for SARS-CoV-2 was 17% (754/4513). African-American race (OR: 1.84, 95% CI: 1.49–2.27) and Hispanic ethnicity (OR: 1.70, 95% CI: 1.35–2.14) were both associated with a significantly higher prevalence of being tested positive compared to White and non-Hispanics, respectively. Older age and male sex were also associated with a higher prevalence of infection. Investigators found that population density partially mediated the association between African-American race and infection.

Study Strengths

The study uses a large, diverse sample of individuals and is one of the first to explore racial and ethnic disparities in SARS-CoV-2 infection. The study also provides a preliminary explanation of the pathways that contribute the association between African-American race and infection.

Limitations

The findings are from a specific center in Houston Texas, results may not be generalizable to the US; however, the sample is demographically diverse. Also, although authors included contextual demographics (e.g. zip code income and population density), it would be helpful to also provide a measure of residential segregation as this could also mediate the relationship between African American race, residing in a high densely populated area, and increased risk of infection.

Value added

This study is one of the first studies to portray racial disparities in the COVID-19 pandemic in a diverse sample and to identify social factors that contribute to said disparities.

This review was posted on: 25 June 2020