Publication Date
4-1-2022
Journal
Journal of Racial and Ethnic Health Disparities
DOI
10.1007/s40615-021-00982-0
PMID
33694124
PMCID
PMC7945621
PubMedCentral® Posted Date
3-10-2021
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
COVID-19, Ethnicity, Hospital Mortality, Humans, Patient Acceptance of Health Care, Retrospective Studies, SARS-CoV-2, United States, Veterans, Veterans Health, COVID19, Disparity, Prevalence, Veteran
Abstract
IMPORTANCE: Recent reports indicate differences in COVID-19-related care and outcomes between Black and White Americans.
OBJECTIVE: We examine the COVID-19-related healthcare utilization and mortality by race and ethnicity of patients tested for SARS-CoV-2 in the Veterans Health Administration (VHA).
DESIGN: A retrospective cohort study.
SETTING: We used the VHA COVID-19 shared data resources between February 1 and June 30, 2020.
PARTICIPANTS: Veterans tested for SARS-CoV-2 virus by VHA.
EXPOSURE(S): Three racial-ethnicity groups of Black, Hispanic, and White (as reference) veterans.
MAIN OUTCOME(S) AND MEASURE(S): Main outcomes are testing rate, positivity rate, hospitalization rate, ICU admission rate, and in-hospital mortality. Controlling for sex, age, and Elixhauser comorbidity index, we report adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) from logistic regression models.
RESULTS: Of the 8,667,996 active veteran enrollees, 252,702 were tested by VHA from February to June, 2020, with 20,500 positive results and 4,790 hospitalizations. The testing rate was 4.4% among Black and 4.7% among Hispanic veterans compared to White veterans, 2.8%. The testing positivity rate was similarly elevated among Black (12.2%) and Hispanic (11.6%) veterans compared to White veterans (6.0%). The aORs of hospitalization in Black veterans (1.88; 95% CI 1.74, 2.03) and Hispanic veterans (1.41; 95% CI 1.25, 1.60) were higher compared to White veterans. No significant differences by race and ethnicity were observed in OR or aOR of ICU admission and in-hospital death among hospitalized patients.
CONCLUSIONS AND RELEVANCE: On a national level, the VHA was more likely to test and hospitalize Black and Hispanic veterans compared to White veterans, but there were no significant differences in ICU admission or in-hospital mortality among those hospitalized. This pattern of differences may relate to social determinants of health, factors affecting access to non-VHA care, or preferences for VHA care affecting initial care seeking, but not in-hospital outcomes.
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