Racial and Ethnic Disparities in SARS-CoV-2 Pandemic: Analysis of a COVID-19 Observational Registry for a Diverse U.S. Metropolitan Population

Introduction

Data on race and ethnic susceptibility to SARS-CoV-2 infection are limited. We analyzed socio-demographic factors associated with higher likelihood of SARS-CoV-2 infection and explore mediating pathways for race disparities in the SARS-CoV-2 pandemic.

Methods

Cross sectional analysis of COVID-19 Surveillance and Outcomes Registry (CURATOR), which captures data for a large healthcare system comprising of one central tertiary care, seven large community hospitals, and an expansive ambulatory / emergency care network in the Greater Houston area. Nasopharyngeal samples for individuals inclusive of all ages, races, ethnicities and sex were tested for SARS-CoV-2. We analyzed, socio-demographic (age, sex, race, ethnicity, household income, residence population density) and comorbidity (hypertension, diabetes, obesity, cardiac disease) factors. Multivariable logistic regression models were fitted to provide adjusted Odds Ratios (aOR), 95% confidence intervals (CI) for likelihood of positive SARS-CoV-2 test. Structural Equation Modeling (SEM) framework was utilized to explore three mediation pathways (low income, high population density, high comorbidity burden) for association between African American race and SARS-CoV-2 infection.

Results

Among 4,513 tested individuals, 754 (16.7%) tested positive. Overall mean (SD) age was 50.6 (18.9) years, 62% females and 26% were African American. African American race was associated with lower socio-economic status, higher comorbidity burden, and population density residence. In the fully adjusted model, African American race (vs. White; aOR, CI: 1.84, 1.49-2.27) and Hispanic ethnicity (vs. non-Hispanic; aOR, CI: 1.70, 1.35-2.14) had a higher likelihood of infection. Older individuals and males were also at a higher risk of SARS-CoV-2 infection. The SEM framework demonstrated a statistically significant (p = 0.008) indirect effect of African American race on SARS-CoV-2 infection mediated via a pathway that included residence in densely populated zip code.

Conclusions

There is strong evidence of race and ethnic disparities in the SARS-CoV-2 pandemic potentially mediated through unique social determinants of health.

Strengths and limitations of this study

• One of the first studies to systematically evaluate race and ethnic disparities in susceptibility to SARS-CoV-2 infection, while accounting for multiple sociodemographic characteristics and comorbidities

• Study population represents a large and diverse metropolitan of the U.S. with data from one of the largest healthcare providers across the greater metropolitan area

• Study evaluates potential mediation pathways for race disparities and demonstrates that residence in areas with high population density may mediate race disparities in susceptibility to SARS-CoV-2 infection

• Single center study with limited information about true burden of comorbidity and lifestyle factors