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Racial Inequities and Access to COVID-19 Treatment.

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Racial and ethnic disparities in COVID-19 treatment exist, with Black and Latino patients receiving fewer oral antiviral prescriptions. Encounter-level factors like diagnostic test type and virtual care access partially explain these gaps, suggesting interventions to improve equity.

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Area of Science:

  • Health Services Research
  • Health Equity
  • Infectious Disease Epidemiology

Background:

  • Timely outpatient treatment for COVID-19 is crucial for high-risk individuals, reducing hospitalization and death.
  • Significant racial and ethnic inequities in COVID-19 treatment have been documented across the United States.
  • The specific care mechanisms contributing to these treatment disparities remain unclear.

Purpose of the Study:

  • To investigate the relative contributions of structural and encounter-level factors to racial and ethnic disparities in oral antiviral prescribing for COVID-19.
  • To identify specific barriers within the healthcare system that exacerbate treatment inequities.
  • To inform targeted interventions aimed at improving equitable access to COVID-19 therapeutics.

Main Methods:

  • A cross-sectional study utilizing electronic health record data from a large northeastern healthcare system.
  • Analysis of patients aged 18+ with positive COVID-19 tests between January 2022 and January 2024.
  • Nested linear probability models adjusted for clinical, public health, and encounter-level characteristics to partition disparities in nirmatrelvir/ritonavir or molnupiravir prescription rates.

Main Results:

  • A total of 201,964 patients were included in the analysis.
  • Unadjusted prescription rates for oral antivirals were significantly lower for Black (10.8 pp) and Hispanic/Latino (9.8 pp) patients compared to White patients.
  • Encounter-level factors, including diagnostic test type (in-clinic vs. home antigen tests) and virtual care access, explained 53% of the gap for Black patients and 39% for Latino patients.

Conclusions:

  • Substantial racial and ethnic disparities exist in outpatient COVID-19 treatment prescribing.
  • Differences in diagnostic testing modalities, virtual care utilization, and site of care are key encounter-level factors contributing to these disparities.
  • Interventions focused on expanding access to rapid testing and virtual care are recommended to promote equitable COVID-19 treatment.