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Differences in COVID-19-Related Testing and Healthcare Utilization by Race and Ethnicity in the Veterans Health
Javad Razjouyan1,2,3, Drew A Helmer1,2, Ang Li1,2
1VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA.
Importance:
Recent reports indicate differences in COVID-19-related care and outcomes between Black and White Americans.
Objective:
We examine the COVID-19-related healthcare utilization and mortality by race and ethnicity of patients tested for SARS-CoV-2 in the Veterans Health Administration (VHA).
Design:
A retrospective cohort study.
Setting:
We used the VHA COVID-19 shared data resources between February 1 and June 30, 2020.
Participants:
Veterans tested for SARS-CoV-2 virus by VHA.
Exposure(S):
Three racial-ethnicity groups of Black, Hispanic, and White (as reference) veterans.
Main Outcome(S) And Measure(S):
Main outcomes are testing rate, positivity rate, hospitalization rate, ICU admission rate, and in-hospital mortality. Controlling for sex, age, and Elixhauser comorbidity index, we report adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) from logistic regression models.
Results:
Of the 8,667,996 active veteran enrollees, 252,702 were tested by VHA from February to June, 2020, with 20,500 positive results and 4,790 hospitalizations. The testing rate was 4.4% among Black and 4.7% among Hispanic veterans compared to White veterans, 2.8%. The testing positivity rate was similarly elevated among Black (12.2%) and Hispanic (11.6%) veterans compared to White veterans (6.0%). The aORs of hospitalization in Black veterans (1.88; 95% CI 1.74, 2.03) and Hispanic veterans (1.41; 95% CI 1.25, 1.60) were higher compared to White veterans. No significant differences by race and ethnicity were observed in OR or aOR of ICU admission and in-hospital death among hospitalized patients.
Conclusions And Relevance:
On a national level, the VHA was more likely to test and hospitalize Black and Hispanic veterans compared to White veterans, but there were no significant differences in ICU admission or in-hospital mortality among those hospitalized. This pattern of differences may relate to social determinants of health, factors affecting access to non-VHA care, or preferences for VHA care affecting initial care seeking, but not in-hospital outcomes.
