Socioeconomic factors mediate association of race/ethnicity with worse outcomes in COVID-19
Black and Hispanic individuals have increased risk for COVID-19 positivity and this association appears to be mediated by socioeconomic factors including population density, income and household size, according to a new study.
“We found that all three socioeconomic factors were associated with higher odds of test positivity, regardless of race or ethnicity,” Hayley B. Gershengorn, MD, associate professor in the division of pulmonary and critical care medicine at the University of Miami Miller School of Medicine, Miami, said in a related press release. “For example, after accounting for other differences, individuals of all races and ethnicities living in the highest population density neighborhoods had 2.5-fold higher odds of test positivity than those living in areas with the lowest population density.”
The retrospective study included two cohorts: 15,473 patients (53.4% women) tested for COVID-19 and 295 patients (52.5% women) hospitalized with COVID-19 from March to July 2020 at the University of Miami Hospital and Clinics. In the cohort of patients tested for COVID-19, 29% were non-Hispanic white, 48.1% were Hispanic white, 15% were non-Hispanic Black, 1.7% were Hispanic Black and 1.6% were of other race. In the cohort of patients hospitalized with COVID-19, 9.2% were non-Hispanic white, 56.9% were Hispanic white, 21.4% were non-Hispanic Black, 2.4% were Hispanic Black and 10.2% were of other race.
Researchers evaluated socioeconomic factors as possible mediators of the association between race/ethnicity and outcomes and assessed whether population density, household income and household size mediated these associations.
Eight percent of those tested had COVID-19 and 15.9% of those hospitalized with COVID-19 died.
After adjustment for demographics, race/ethnicity was associated with test positivity and hospitalization, according to the results. Compared with non-Hispanic white individuals, the OR for test positivity was 3.21 (95% CI, 2.6-3.96) for non-Hispanic Black individuals, 2.72 (95% CI, 2.28-3.26) for Hispanic white individuals and 3.55 (95% CI, 2.33-5.28) for Hispanic Black individuals. Similarly, compared with non-Hispanic white individuals, the OR for COVID-19 hospitalization was 4.75 (95% CI, 3.38-6.76) for non-Hispanic black individuals, 3.81 (95% CI, 2.84-5.21) for Hispanic white individuals and 4.34 (95% CI, 2.21-7.93) for Hispanic black individuals, according to the results.
Socioeconomic factors mediated the association between test positivity and race/ethnicity: median income mediated 27%, household size mediated 20% and population density mediated 17%.
Researchers observed no association between race/ethnicity and mortality in this study.
The researchers said further research in other regions of the United States and the world and in different ethnic/racial groups with different socioeconomic pressures, may provide further insights.