Where Inequities Emerge: Racial and Ethnic Differences Across the COVID-19 Hospitalization Continuum

Area of Science:

• Public Health
• Health Equity
• Epidemiology

Background:

• COVID-19 exacerbated existing racial and ethnic inequities in healthcare access and outcomes.
• Underserved populations, particularly racial minorities, faced disproportionate impacts during the pandemic.
• Understanding inequities across the hospitalization continuum is crucial for targeted interventions.

Purpose of the Study:

• To examine racial and ethnic inequities in COVID-19 hospitalization and in-hospital mortality among Kentucky Medicaid beneficiaries.
• To analyze disparities from initial diagnosis through in-hospital outcomes.
• To identify at which stage of hospitalization racial inequities are most pronounced.

Main Methods:

• Retrospective cohort study of Kentucky Medicaid beneficiaries hospitalized in 2020-2021.
• Analysis of statewide hospitalization data using multivariable regression models.
• Propensity score matching (PSM) used for confirmatory analysis of mortality patterns.

Main Results:

• Non-Hispanic Black patients had a higher likelihood of COVID-19 hospitalization compared to non-Hispanic White patients (aOR=1.41).
• COVID-19 hospitalizations were associated with significantly higher in-hospital mortality (aHR=2.38).
• No significant Black-White differences in in-hospital mortality were found for COVID-19 cases, with PSM confirming these findings.

Conclusions:

• Racial inequities in COVID-19 care were more evident at hospital admission than during inpatient treatment.
• Focusing on prevention, early diagnosis, and timely outpatient care is essential to address these disparities.
• Interventions should target pre-hospitalization and admission stages to mitigate racial inequities in COVID-19 outcomes.