More than two years into the pandemic, multiple analyzes of federal, state, and local data have shown that people of color have been, and continue to be, disproportionately affected by COVID-19. New research from doctors and researchers from the Mid-Atlantic Permanente Research Institute (MAPRI) and the Mid-Atlantic Permanente Medical Group shows that these disparities also existed in the early months of the pandemic and were more likely to negatively affect black and Hispanic men. The study, “Differences in COVID-19 Testing and Negative Results by Race, Ethnicity, Gender, and Health System Setting in a Large Diverse Population of the United States,” was published in Plus one.
From March 2020 to August 2020,
Hispanic patients had the highest rates of COVID-19 PCR testing and positivity.
Both black male and female patients were more likely to be hospitalized with COVID-19 than white patients.
Black men were more likely to die from COVID-19.
Regardless of race, men were more likely to be hospitalized or die from COVID-19 than women.
Men of any race were less likely to be tested for COVID-19, yet they were more likely to be infected with COVID-19 when they took the test.
The percentage of patients hospitalized with COVID-19 and overall death rates from COVID-19 were lower in integrated health systems (such as Kaiser Permanente) regardless of race or sex.
Understanding the differences between different population groups helps us to identify where there are gaps in care. Studies like ours show us that medical systems nationwide need to be more proactive in ensuring that everyone has access to equitable health care, especially during a global pandemic.”
Eric Watson, co-author of the study and director of research data analytics for the Permanente Mid-Atlantic Research Institute
Researchers analyzed the electronic medical records of more than five million adult patients across multiple medical systems across the United States from March 2020 to August 2020.
COVID-19 test and positivity rates
The analyzes found that Hispanic patients had the highest rates of COVID-19 PCR testing and positivity. These findings were in line with other reports showing Hispanic patients were two and a half times more likely to contract COVID-19 than their white counterparts.
“Some patients in this population were unable to work from home or from social distance during the height of the lockdown,” said study co-author and infectious disease physician Michael Horberg. “This would have resulted in an increased risk of exposure to COVID-19, and therefore a higher proportion of patients who tested positive.”
Asian/Pacific Islanders had low rates of COVID-19 PCR testing and low positivity rates. White patients had the lowest overall positive rates for COVID-19 despite having high testing rates. Compared to women, men of any race were less likely to be tested for COVID-19 and yet were more likely to be infected with COVID-19 when given the test.
A total of 5,724 patients studied were hospitalized with COVID-19 infection. The study found that black patients were more likely to be hospitalized with COVID-19 than white patients. Regardless of race, men have been hospitalized with COVID-19 more frequently than women. The authors said that many factors could have led to severe outcomes for black patients and men during this time frame.
“We know that in general, men are less likely to seek care when they are sick,” Watson explained. “Delaying care for COVID-19 may lead to more serious outcomes.”
Nearly 1,400 patients studied died after being hospitalized with COVID-19. Black men experienced the highest death rates, followed by Hispanic men.
The importance of increasing access to care
The researchers noted that patients who received care within integrated health systems such as Kaiser Permanente were less likely to experience severe outcomes from COVID-19 than those in academic health systems. The percentage of patients hospitalized with COVID-19 and overall death rates from COVID-19 were lower in integrated health systems regardless of race or gender.
“Our model of care makes it easier for patients to prevent and treat disease,” Watson explained. “Our patients have a team of physicians who guide them throughout their health journey. If they are sick, their care team can quickly and seamlessly point them in the right direction to get the right care. Not all health systems can do this.”
Dr. Horberg said that while integrated health systems have improved outcomes, health disparities still exist. He hopes that future research will be able to better identify how to fill the gaps in care.
“Although access to care is important, it marks the end of the inequality pathway, not the beginning,” said Dr. Horberg. “We need to better understand how individual, family and structural differences among specific populations are the driving forces for disparities in testing and outcomes related to COVID-19.”
Clinicians and research scientists from the Mid-Atlantic Permanente Research Institute are currently participating in a variety of studies related to prolonged COVID, formally known as post-acute sequelae of SARS CoV-2 (PASC) infection. This research will also analyze health disparities related to vaccination status.
“If someone is vaccinated against COVID-19, it is very unlikely that they will experience symptoms of PASC,” Watson said. “So, if we find that there was a disparity among those who received the vaccine, there is likely to be a disparity in people who had more severe symptoms or symptoms of PASC.”