Understanding contributors to racial and ethnic inequities in COVID-19 incidence and mortality rates.

Karen E Joynt Maddox,Joseph T Steensma,Aaloke Mody,Mat Reidhead,Joshua Grotzinger,Abigail R Barker,Will Ross,Elna Nagasako,Timothy Mcbride,Fernando A Wilson

doi:10.1371/journal.pone.0260262

Karen E Joynt Maddox, Joseph T Steensma + Show 8 more

Open Access

https://doi.org/10.1371/journal.pone.0260262

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Abstract

Racial inequities in Coronavirus 2019 (COVID-19) have been reported over the course of the pandemic, with Black, Hispanic/Latinx, and Native American individuals suffering higher case rates and more fatalities than their White counterparts. We used a unique statewide dataset of confirmed COVID-19 cases across Missouri, linked with historical statewide hospital data. We examined differences by race and ethnicity in raw population-based case and mortality rates. We used patient-level regression analyses to calculate the odds of mortality based on race and ethnicity, controlling for comorbidities and other risk factors. As of September 10, 2020 there were 73,635 confirmed COVID-19 cases in the State of Missouri. Among the 64,526 case records (87.7% of all cases) that merged with prior demographic and health care utilization data, 12,946 (20.1%) were Non-Hispanic (NH) Black, 44,550 (69.0%) were NH White, 3,822 (5.9%) were NH Other/Unknown race, and 3,208 (5.0%) were Hispanic. Raw cumulative case rates for NH Black individuals were 1,713 per 100,000 population, compared with 2,095 for NH Other/Unknown, 903 for NH White, and 1,218 for Hispanic. Cumulative COVID-19-related death rates for NH Black individuals were 58.3 per 100,000 population, compared with 38.9 for NH Other/Unknown, 19.4 for NH White, and 14.8 for Hispanic. In a model that included insurance source, history of a social determinant billing code in the patient's claims, census block travel change, population density, Area Deprivation Index, and clinical comorbidities, NH Black race (OR 1.75, 1.51-2.04, p<0.001) and NH Other/Unknown race (OR 1.83, 1.36-2.46, p<0.001) remained strongly associated with mortality. In Missouri, COVID-19 case rates and mortality rates were markedly higher among NH Black and NH Other/Unknown race than among NH White residents, even after accounting for social and clinical risk, population density, and travel patterns during COVID-19.

Highlights

Racial inequities in case rates and clinical outcomes from the Coronavirus 2019 (COVID-19) have been reported over the course of the pandemic, with Black, Hispanic/Latinx, and Native American individuals suffering markedly higher case rates and more fatalities than their White counterparts [1]
In Missouri, COVID-19 case rates and mortality rates were markedly higher among NH Black and NH Other/Unknown race than among NH White residents, even after accounting for social and clinical risk, population density, and travel patterns during COVID-19
Using a unique statewide dataset of confirmed COVID-19 cases across Missouri, linked with historical statewide hospital data, we examined differences by race and ethnicity in raw population-based case and mortality rates, and used patient-level regression analyses to calculate the odds of mortality based on race and ethnicity

Summary

Introduction

Racial inequities in case rates and clinical outcomes from the Coronavirus 2019 (COVID-19) have been reported over the course of the pandemic, with Black, Hispanic/Latinx, and Native American individuals suffering markedly higher case rates and more fatalities than their White counterparts [1]. There are a number of potential contributors to racial inequities in COVID19 [2] These include risk factors for exposure to the disease such as essential worker status, use of public transportation, and population density [3,4,5], as well as risk factors for poor outcomes among people with established disease, including comorbidities and social determinants of health such as poverty, education, access to care, and insurance coverage that are known to be associated with adverse health outcomes more broadly [6,7,8,9,10,11]. Racial inequities in Coronavirus 2019 (COVID-19) have been reported over the course of the pandemic, with Black, Hispanic/Latinx, and Native American individuals suffering higher case rates and more fatalities than their White counterparts

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