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Racial and Ethnic Disparities in Rates of COVID-19-Associated Hospitalization, Intensive Care Unit Admission, and
Anna M Acosta1, Shikha Garg1,2, Huong Pham1
1COVID-19-Associated Hospitalization Surveillance Network, US Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
Racial and ethnic minority groups experienced higher rates of severe COVID-19, including hospitalization, intensive care unit (ICU) admission, and death. Addressing these disparities requires equitable access to preventive measures like vaccination.
Area of Science:
- Public Health
- Epidemiology
- Health Disparities
Background:
- Racial and ethnic minority groups face disproportionate impacts from COVID-19.
- Understanding disparities in severe COVID-19 outcomes is crucial for public health interventions.
Purpose of the Study:
- To evaluate severe COVID-19 rates (hospitalization, ICU admission, death) among racial and ethnic minority groups compared to non-Hispanic White individuals.
- To quantify the disparities in COVID-19-associated hospitalizations and mortality across different racial and ethnic populations in the US.
Main Methods:
- A cross-sectional study analyzed data from 14 US states within the COVID-19-Associated Hospitalization Surveillance Network.
- Included were 143,342 patients hospitalized with COVID-19 from March 2020 to February 2021, with race and ethnicity data.
- Age-adjusted rates and rate ratios (RR) were calculated for hospitalization, ICU admission, and death, comparing minority groups to White individuals.
Main Results:
- American Indian/Alaska Native, Latino, and Black individuals showed significantly higher rates of hospitalization, ICU admission, and death compared to White individuals.
- Asian/Pacific Islander individuals also had higher rates for hospitalization, ICU admission, and death, though the rate ratios were lower than other minority groups.
- Specific rate ratios indicated substantial disparities, for example, American Indian/Alaska Native individuals had an RR of 7.19 for death.
Conclusions:
- Racial and ethnic minority groups experienced significantly higher severe COVID-19 outcomes during the first year of the pandemic.
- These findings highlight persistent racial and ethnic disparities in COVID-19 severity.
- Equitable access to preventive measures, including vaccination, is essential to mitigate these disparities.
Importance:
Racial and ethnic minority groups are disproportionately affected by COVID-19.
Objectives:
To evaluate whether rates of severe COVID-19, defined as hospitalization, intensive care unit (ICU) admission, or in-hospital death, are higher among racial and ethnic minority groups compared with non-Hispanic White persons.
Design, Setting, And Participants:
This cross-sectional study included 99 counties within 14 US states participating in the COVID-19-Associated Hospitalization Surveillance Network. Participants were persons of all ages hospitalized with COVID-19 from March 1, 2020, to February 28, 2021.
Exposures:
Laboratory-confirmed COVID-19-associated hospitalization, defined as a positive SARS-CoV-2 test within 14 days prior to or during hospitalization.
Main Outcomes And Measures:
Cumulative age-adjusted rates (per 100 000 population) of hospitalization, ICU admission, and death by race and ethnicity. Rate ratios (RR) were calculated for each racial and ethnic group compared with White persons.
Results:
Among 153 692 patients with COVID-19-associated hospitalizations, 143 342 (93.3%) with information on race and ethnicity were included in the analysis. Of these, 105 421 (73.5%) were 50 years or older, 72 159 (50.3%) were male, 28 762 (20.1%) were Hispanic or Latino, 2056 (1.4%) were non-Hispanic American Indian or Alaska Native, 7737 (5.4%) were non-Hispanic Asian or Pacific Islander, 40 806 (28.5%) were non-Hispanic Black, and 63 981 (44.6%) were White. Compared with White persons, American Indian or Alaska Native, Latino, Black, and Asian or Pacific Islander persons were more likely to have higher cumulative age-adjusted rates of hospitalization, ICU admission, and death as follows: American Indian or Alaska Native (hospitalization: RR, 3.70; 95% CI, 3.54-3.87; ICU admission: RR, 6.49; 95% CI, 6.01-7.01; death: RR, 7.19; 95% CI, 6.47-7.99); Latino (hospitalization: RR, 3.06; 95% CI, 3.01-3.10; ICU admission: RR, 4.20; 95% CI, 4.08-4.33; death: RR, 3.85; 95% CI, 3.68-4.01); Black (hospitalization: RR, 2.85; 95% CI, 2.81-2.89; ICU admission: RR, 3.17; 95% CI, 3.09-3.26; death: RR, 2.58; 95% CI, 2.48-2.69); and Asian or Pacific Islander (hospitalization: RR, 1.03; 95% CI, 1.01-1.06; ICU admission: RR, 1.91; 95% CI, 1.83-1.98; death: RR, 1.64; 95% CI, 1.55-1.74).
Conclusions And Relevance:
In this cross-sectional analysis, American Indian or Alaska Native, Latino, Black, and Asian or Pacific Islander persons were more likely than White persons to have a COVID-19-associated hospitalization, ICU admission, or in-hospital death during the first year of the US COVID-19 pandemic. Equitable access to COVID-19 preventive measures, including vaccination, is needed to minimize the gap in racial and ethnic disparities of severe COVID-19.
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