Differences in COVID-19-Related Testing and Healthcare Utilization by Race and Ethnicity in the Veterans Health Administration
Tóm tắt
Recent reports indicate differences in COVID-19-related care and outcomes between Black and White Americans. 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). A retrospective cohort study. We used the VHA COVID-19 shared data resources between February 1 and June 30, 2020. Veterans tested for SARS-CoV-2 virus by VHA. Three racial-ethnicity groups of Black, Hispanic, and White (as reference) veterans. 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. 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. 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.
Tài liệu tham khảo
Evans MK. Covid’s Color Line—Infectious Disease, Inequity, and Racial Justice. N Engl J Med. 2020;383(5):408–10.
Millett GA, Jones AT, Benkeser D, Baral S, Mercer L, Beyrer C, et al. Assessing differential impacts of COVID-19 on black communities. Ann Epidemiol. 2020;47:37–44.
Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, el Burai Felix S, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(24):759–65.
Renelus BD, et al., Racial disparities in COVID-19 hospitalization and in-hospital mortality at the height of the New York City pandemic. J Racial Ethn Health Disparities. 2020;1–7.
Rentsch CT, et al. Covid-19 by race and ethnicity: a national cohort study of 6 million United States veterans. medRxiv. 2020.
Killerby ME, Link-Gelles R, Haight SC, Schrodt CA, England L, Gomes DJ, et al. Characteristics associated with hospitalization among patients with COVID-19—Metropolitan Atlanta, Georgia, March–April 2020. Morb Mortal Wkly Rep. 2020;69(25):790–4.
Gold JA. Characteristics and clinical outcomes of adult patients hospitalized with COVID-19—Georgia, March 2020. MMWR Morb Mortal Wkly Rep. 2020:69.
Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among Black patients and White patients with Covid-19. N Engl J Med. 2020;382(26):2534–43.
Development, O.o.R. Overview of VA research on Health Equity. 2020 cited 2020; Available from: https://www.research.va.gov/topics/health_equity.cfm.
Peterson K, Anderson J, Boundy E, Ferguson L, McCleery E, Waldrip K. Mortality disparities in racial/ethnic minority groups in the Veterans Health Administration: an evidence review and map. Am J Public Health. 2018;108(3):e1–e11.
Selim AJ, Fincke G, Berlowitz DR, Cong Z, Miller DR, Ren XS, et al. No racial differences in mortality found among Veterans Health Administration out-patients. J Clin Epidemiol. 2004;57(5):539–42.
Burgess DJ, van Ryn M, Grill J, Noorbaloochi S, Griffin JM, Ricards J, et al. Presence and correlates of racial disparities in adherence to colorectal cancer screening guidelines. J Gen Intern Med. 2011;26(3):251–8.
Atkins D, Kilbourne A, Lipson L. Health equity research in the Veterans Health Administration: we’ve come far but aren’t there yet. Am Publ Health Assoc. 2014.
Bhargava A, Kim T, Quine DB, Hauser RG. A 20-year evaluation of LOINC in the United States’ largest integrated health system. Arch Pathol Lab Med. 2020;144(4):478–84.
Mor M. Assessing race and ethnicity. Pittsburgh: Veterans Affairs VIReC Database and Methods Cyberseminar Series; 2014. Retrieved from http://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/763-notes. pdf
Maynard C. Ascertaining veterans’ vital status: VA data sources for mortality ascertainment and cause of death. Database & Methods Cyberseminar Series. 2017.
Wilcox AJ. Length of intensive care unit stay computed from the VHA corporate data warehouse. NEGSUG2012. Baltimore, Maryland, 2012.
Scott DuVall JS. Introduction to the VA COVID-19 shared data resource and its use for research. 2020. Available from: https://www.hsrd.research.va.gov/cyberseminars/catalog-upcoming-session.cfm?UID=3810.
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.
CDC. Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19. 2019.
Wadhera RK, Wadhera P, Gaba P, Figueroa JF, Joynt Maddox KE, Yeh RW, et al. Variation in COVID-19 hospitalizations and deaths across New York City boroughs. JAMA. 2020;323:2192–5.
Pan D, Sze S, Minhas JS, Bangash MN, Pareek N, Divall P, et al. Ta systematic review. EClinicalMedicine. 2020;23:100404.
de Lusignan S, et al. Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross-sectional study. Lancet Infect Dis. 2020.
Dyer O. Covid-19: Black people and other minorities are hardest hit in US. Br Med J. 2020; Publishing Group.
Fiscella K, Franks P, Gold MR, Clancy CM. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000;283(19):2579–84.
Haro E, Mader M, Noël PH, Garcia H, Vogt D, Bernardy N, et al. The impact of trust, satisfaction, and perceived quality on preference for setting of future care among veterans with PTSD. Mil Med. 2019;184(11-12):e708–14.
Kondo K, et al., Prevalence of and interventions to reduce health disparities in vulnerable veteran populations: a map of the evidence. 2017.
Kondo K, et al. Health disparities in veterans: a map of the evidence. Med Care. 2017;55(Suppl 9 Suppl 2):S9–S15.
Saha S, Freeman M, Toure J, Tippens KM, Weeks C, Ibrahim S. Racial and ethnic disparities in the VA health care system: a systematic review. J Gen Intern Med. 2008;23(5):654–71.
Gollust SE, et al. What causes racial health care disparities? A mixed-methods study reveals variability in how health care providers perceive causal attributions. INQUIRY: J Health Care Organ Prov Financ. 2018;55:0046958018762840.