Study Finds Social Determinants Impact Outcomes of Minorities with COVID-19

People from racial and ethnic minority groups had higher risks of COVID-19 infections, but outcomes varied based on access to primary care physicians and insurance.

Members of racial and ethnic minority groups had higher risks of COVID-19 infection and disease severity, according to a recent study published in JAMA Network Open. They found that people who are African American, Asian American, and Hispanic were significantly more likely to test positive for COVID-19 than White individuals.

“Our results are consistent with previous findings that suggest that racial and ethnic minority groups face a higher risk of ICU admission and COVID-19 positivity but a lower risk of mortality than White populations. However, current meta-analyses do not provide associations with socioeconomic variables, which are highly implicated in COVID-19 outcomes,” wrote investigators, who were led by Shruti Magesh and Daniel John, both with the department of surgery at the University of California, San Diego.

In this study, investigators examined the associations of race and ethnicity with COVID-19 positivity rates, mortality, hospitalization, and ICU admissions in the United States. Then they associated these outcomes with various social determinants through adjusted and unadjusted relative risk ratio (RR) and odds ratio (OR) calculations.

Investigators searched databases for studies published between Jan. 1, 2020, and Jan. 6, 2021. They found 68 studies where they could examine the association of clinical care quality with COVID-19 positivity, mortality, ICU admission, and hospitalization. They assessed preventable hospital stays, ratio of the population to primary care physicians, and percentage of uninsured individuals, as well as disease severity through ICU admission and hospitalization rates among various racial and ethnic groups.

Although people from racial and ethnic minority groups had higher risks of COVID-19, the outcomes varied among patient populations. For example, investigators found that increased deprivation was associated with increased mortality, especially among Asian Americans, but the opposite was true for Hispanics. Investigators said this inconsistency suggests that further research is needed of COVID-19 infections among Hispanics.

Additionally, an increase in county median income was associated with increased mortality rates in Asian Americans. Investigators speculated that a large number of Asian Americans work in healthcare settings where their exposure to the COVID-19 was higher.

Investigators also found that lack of insurance among African Americans and a lack of access to primary care among Hispanics were associated with higher COVID-19 infections.

Investigators pointed out the studies they assessed had incomplete or missing data on mortality, positivity, ICU admission, and hospitalization rates. There was also limited data on racial and ethnic groups and a lack of information on comorbidities in some studies.