More than two years into the pandemic, multiple analyzes of federal, state and local data show that people of color have been and continue to be disproportionately impacted by COVID-19. New research by 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 impact negative on black and Hispanic men. The study, “Differences in COVID-19 testing and adverse outcomes by race, ethnicity, gender, and healthcare system in a large, diverse U.S. cohort,” was published in PLOS One.

Main findings:

From March 2020 to August 2020,

• Hispanic patients had the highest rates of COVID-19 PCR tests and positivity.

• Black patients, both male and female, were more likely to be hospitalized with COVID-19 than white patients.

• Black men were most at risk of death from COVID-19.

• Regardless of ethnicity, men were more likely to be hospitalized or die from COVID-19 than women.

• Men of any ethnicity were less likely to test for COVID-19, but were more likely to test positive for COVID-19 when tested.

• The percentage of patients hospitalized with COVID-19 and overall death rates from COVID-19 were lower in integrated health systems (eg Kaiser Permanente) regardless of race or gender.

Understanding the disparities of different populations helps us identify where there are gaps in care. Studies like ours show us that nationally, medical systems need to be more proactive to ensure everyone has access to equitable health care, especially during a global pandemic.”

Eric Watson, study co-author and director of research data analysis for the Mid-Atlantic Permanente Research Institute

The researchers analyzed the electronic medical records of more than five million adult patients in multiple medical systems across the United States from March 2020 through August 2020.

COVID-19 tests and positivity rate

Analyzes revealed that Hispanic patients had the highest rates of COVID-19 PCR tests and positivity. These results were consistent with other reports showing that Hispanic patients were more than two and a half times more likely to test positive for COVID-19 than their white counterparts.

“Some patients in this population were unable to work from home or social distance during the height of the shutdowns,” said study co-author and infectious disease physician Michael Horberg, MD. “This could have resulted in an increased risk of exposure to COVID-19, therefore a greater proportion of patients testing positive.”

Asian and Pacific Islanders had low COVID-19 PCR testing rates and low positivity rates. White patients had the lowest overall COVID-19 positivity rates despite high testing rates. Compared to women, men of any ethnicity were less likely to test for COVID-19, but were more likely to test positive for COVID-19 when they did.

Hospitalization

A total of 5,724 patients studied were hospitalized due to COVID-19 infection. The study found that black patients were more likely to be hospitalized with COVID-19 than white patients. Regardless of ethnicity, men have been hospitalized with COVID-19 more frequently than women. The authors said that many factors could have led to serious outcomes for black patients and men during this time.

“We know that in general men are less likely to seek care when they are sick,” Watson explained. “Delaying care for COVID-19 could lead to more serious outcomes.”

Death

Nearly 1,400 patients studied have died after being hospitalized with COVID-19. Black men had the highest death rates, followed closely by Hispanic men.

The importance of better access to care

The researchers noted that patients who received care in integrated healthcare systems like Kaiser Permanente were less likely to suffer serious consequences from COVID-19 compared to academic healthcare 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 through their health journey. If they are ill, their care team can quickly and seamlessly steer them in the right direction to seek appropriate care. All health systems can’t do it.”

Dr. Horberg said that although integrated health systems have improved outcomes, there are still health disparities. He hopes that future research can identify how to better close gaps in care.

“While access to care is important, it represents the end of the disparity path, not the beginning,” Dr. Horberg said. “We need to better understand how individual, family and structural differences within certain populations may drive disparities in testing and outcomes related to COVID-19.

Future research

Physicians and researchers at the Mid-Atlantic Permanente Research Institute are currently involved in various studies regarding long COVID, officially known as post-acute sequelae of SARS CoV-2 infection (PASC). This research will also analyze health disparities related to vaccination status.

“If someone is vaccinated against COVID-19, they are less likely to have symptoms of PASC,” Watson said. “So if we find that there is a disparity between those who received the vaccine, there could potentially be a disparity between those who had more severe acute symptoms or symptoms of PASC.”