Racial/Ethnic Disparities in Hospital Admissions from COVID 19 and Determining the Impact of Neighborhood Deprivation and Primary Language.
Importance Despite past and ongoing efforts to achieve health equity in the United States, persistent disparities in socioeconomic status along with multilevel racism maintain disparate outcomes and appear to be amplified by COVID 19. Objective Measure socioeconomic factors and primary language effects on the risk of COVID 19 severity across and within racial/ethnic groups. Design Retrospective cohort study. Setting Health records of 12 Midwest hospitals and 60 clinics in the U.S. between March 4, 2020 to August 19, 2020. Participants PCR+ COVID 19 patients. Patients missing race or ethnicity data or those diagnosed with COVID 19 during a hospitalization were excluded. Exposures Main exposures included race/ethnicity, area deprivation index (ADI) and primary language. Main Outcomes and Measures The primary outcome was COVID 19 severity using hospitalization within 45 days of diagnosis. Logistic and competing risk regression models (censored at 45 days and accounting for the competing risk of death prior to hospitalization) assessed the effects of neighborhood level deprivation (using the ADI) and primary language. Within race effects of ADI and primary language were measured using logistic regression. Results 5,577 COVID 19 patients were included, 866 (n=15.5% were hospitalized within 45 days of diagnosis. Hospitalized patients were older (60.9 years, IQR: 45.7 75.9 vs. 40.4 years, IQR: 25.6 58.3, p<0.001) and more likely to be male (n=425 [49.1% vs. 2,049 [43.5% p=0.002) Of those requiring hospitalization, 43.9% (n=381) 19.9% (n=172) 18.6% (n=161) and 11.8% (n=102) were White, Black, Asian, and Hispanic, respectively. Independent of ADI, minority race/ethnicity was associated with COVID 19 severity; Hispanic patients (OR 3.8, 95% CI 2.72 5.30) Asians (OR 2.39, 95% CI 1.74 3.29) and Blacks (OR 1.50, 95% CI 1.15 1.94) Surprisingly ADI was not associated with hospitalization; however, consistent trends within racial/ethnic groups were observed. Furthermore, non English speaking (OR 1.91, 95% CI 1.51 2.43) significantly increased odds of hospital admission across and within minority groups. Conclusions Minority populations have increased odds of severe COVID 19 independent of neighborhood deprivation, a commonly suspected driver of disparate outcomes during the pandemic. Non English speaking also accounts for between and within minority populations. These results support continued concern that racism contributes to disparities during COVID 19 while also highlighting the underappreciated role primary language plays in COVID 19 severity across and within minority groups.
medRxiv