What data on 4.3 million patients shows about racial disparities amid the pandemic

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Racial and ethnic minorities are at an increased risk for COVID-19 infection and severity, but at lower risks for death, a study published Nov. 11 in JAMA Open Network found. 

Researchers performed a systematic review and meta-analysis of 4.3 million patients from 68 studies from Jan. 1, 2020, to Jan. 6, 2021. 

They used the Area Deprivation Index to measure socioeconomic disadvantage and the Urban Core Opportunity Index to measure urbanicity. Clinical care quality was reviewed by preventable hospital stays, ratio of patients to primary care physicians, and percentage of uninsured.

Noted limitations for the study included high heterogeneity statistics, incomplete or missing data on mortality, positivity, ICU admission, and hospitalization rates in some publications, limited data on several racial and ethnic groups and a lack of information on comorbidities in some studies.

"Collectively, our findings demonstrate that racial and ethnic minority groups have faced higher risk of COVID-19 positivity and ICU admission," researchers wrote.

Seven key findings: 

  • In an analysis adjusted for age and sex, Black and Hispanic Americans were most likely to contract COVID-19 and Asian Americans were at highest risk for ICU admission. 

  • In cohort studies, the combined prevalence of COVID-19 mortality rates were highest among white individuals, African American individuals, Hispanic Americans and Asian Americans while in cross-sectional studies, the combined prevalence of mortality rates were highest among African American individuals, Hispanic individuals, white individuals and Asian Americans.

  • Increased deprivation was found to be associated with increased mortality in Asian Americans and an increase in county median income was associated with increased mortality rates in Asian Americans. 

  • An increase in deprivation was found to be associated with decreased mortality rates in Hispanic individuals in cohort studies with the opposite result in cross-sectional studies.

  • In cohort studies, an increase in the number of preventable hospital stays and the population served by one primary care physician were associated with a decrease in positivity among Asian Americans and positively associated with positivity among Hispanic individuals 

  • In cross-sectional studies, the ratio of the population served to primary care physicians was positively correlated with mortality among white individuals.

  • The percentage of uninsured individuals was positively associated with positivity among African American an white individuals in cohort and cross-sectional studies.

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