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Ethnicity, Comorbid Medical Conditions, and SARS-CoV-2 Test Cycle Thresholds in the Veteran Population
Jeffrey Petersen1,2, Darshana Jhala3,4
1Department of Pathology and Laboratory Medicine, Corporal Michael J Crescenz Veteran Affairs Medical Center (CMCVAMC), 3900 Woodland Ave, Philadelphia, PA, 19104, USA.
Insights
African American Veterans had higher COVID-19 infection rates and ICU care needs. Despite similar comorbidities and viral loads, this highlights health disparities in COVID-19 outcomes.
Area of Science:
- Public Health
- Infectious Diseases
- Health Disparities
Background:
- COVID-19 disproportionately affects African Americans due to societal factors.
- Higher viral loads (lower CT/CN values) may correlate with disease severity.
- Ethnic differences in viral loads and comorbidities are understudied.
Purpose of the Study:
- To investigate COVID-19 cycle threshold/number (CT/CN) values by ethnicity and comorbid medical history.
- To understand the role of viral loads in differential public health outcomes.
- To address a gap in the literature concerning ethnicity, comorbidities, and viral loads.
Main Methods:
- Retrospective review of SARS-CoV-2 RT-PCR tests at a Philadelphia VAMC (March-May 2020).
- Collected demographic data (race, gender, age), comorbidities, clinical course, and CT/CN values for positive cases.
- Analyzed 1524 patients, including 713 African Americans.
Main Results:
- 187/1524 patients tested positive for SARS-CoV-2; 74% were African American.
- African American patients required more intensive care unit (ICU) care.
- Similar rates of comorbid conditions and statistically non-significant lower viral loads in African Americans.
Conclusions:
- African American Veterans had higher rates of positive COVID-19 tests and required more ICU care.
- These disparities persisted despite similar comorbidity rates and viral loads.
- Findings underscore the need to address health disparities in COVID-19 outcomes.
Background And Aims:
It has been documented that African Americans have been significantly affected by COVID-19 infection due to systemic societal factors, which may lead to increases in comorbid medical history and subsequently vulnerability to having higher viral loads as measured by the cycle threshold/number (CT/CN) values by reverse transcriptase polymerase chain reaction (RT-PCR). Differences in CT/CN values by ethnicity and comorbid medical history could play an important role in public health research, particularly in elucidating the reasons for differential public health outcomes by ethnicity, as viral loads are known to correlate with disease severity. However, there is a gap in the literature regarding CT/CN values by ethnicity and comorbid medical history. Therefore, this study seeks to address this literature gap and its important implication for public health research.
Methods:
A retrospective review of all SARS-CoV-2 RT-PCR tests collected at the regional Veterans Administration Medical Center (VAMC) serving the Philadelphia area from March 17, 2020, to May 20, 2020, was performed to collect demographic information such as race, gender, and age. In addition, comorbid medical conditions, clinical course, and CT/CN values were obtained for the positive cases.
Results:
There was a total of 1524 patients tested for SARS-CoV-2. A total of 713/1524 patients (46.8%) were African American. A total of 187/1524 patients (12%) had tested positive for SARS-CoV-2 from which 139/187 (74%) were African American. African American patients required more intensive unit care. Both African Americans and other ethnicities had similar rates of comorbid medical conditions. On comparison of the ethnic groups, there were lower viral loads in African Americans on admission, though the difference was not statistically significant.
Conclusion:
African American Veterans tested positive at higher rates and require more ICU care, despite similar rates of comorbid illness and viral loads.
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