The Association Between Race and Risk of COVID-19 Hospitalization: Examining the Contribution of Social Determinants...

COVID-19 disproportionately affected Black Americans, and social determinants of health (SDOH) likely contributed to this disparity, yet their impact remains unclear. This study investigated the association between race and COVID-19-related hospitalization, assessing the added explanatory value of SDOH and clinical factors.

In this observational study, we invited 22,895 adult (≥ 18 years) Kaiser Permanente Georgia (KPGA) members with a COVID-19 diagnosis between Jan. 2020 and Jun. 2021 to take a survey of which 482 participated (response rate = 2.1%). We included non-Hispanic Black or non-Hispanic White KPGA members with complete data (n = 306). Surveys were linked to KPGA's electronic medical records. Multivariable logistic regression assessed the relationship between race (non-Hispanic Black compared with White) and likelihood of 30-day hospitalization post-COVID-19 diagnosis adjusting for clinical factors (demographics, comorbidities) and SDOH (neighborhood SDOH, pre-COVID-19 health behaviors, and COVID-19 social impacts). Max-scaled R-squares and likelihood ratio tests assessed model variation and covariate significance.

Our study population was 39.2% Black, 32.4% male, and mean age was 52.3 ± 13.3 years. Overall, 20.0% of Black and 12.4% of White members were hospitalized within 30 days of COVID-19 diagnosis. While not statistically significant, Black (compared with White) members were 72% (aOR: 1.72 [95% CI: 0.75 3.91]) more likely to be hospitalized. Race, clinical factors, and SDOH explained 1.8%, 18.6%, and 14.4% of the variation in hospitalization risk, respectively, and cumulatively explained 34.8%.

No significant racial differences in 30-day hospitalization were observed; however, we found that clinical factors and SDOH explained similar variation in hospitalization risk.