Racial and Neighborhood-Level Disparities in COVID-19 Incidence among Patients on Hemodialysis in New York City.
Adolescent
Adult
Black or African American
Aged
Aged, 80 and over
COVID-19
/ complications
Cohort Studies
Female
Health Status Disparities
Hispanic or Latino
Humans
Incidence
Kidney Failure, Chronic
/ complications
Male
Middle Aged
New York City
/ epidemiology
Pandemics
Renal Dialysis
Residence Characteristics
Retrospective Studies
Risk Factors
SARS-CoV-2
Socioeconomic Factors
Vulnerable Populations
White People
Young Adult
COVID-19
disparities
hemodialysis
social determinants of health
Journal
Journal of the American Society of Nephrology : JASN
ISSN: 1533-3450
Titre abrégé: J Am Soc Nephrol
Pays: United States
ID NLM: 9013836
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
16
11
2020
accepted:
15
03
2021
pubmed:
5
6
2021
medline:
6
8
2021
entrez:
4
6
2021
Statut:
ppublish
Résumé
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected socially disadvantaged populations. Whether disparities in COVID-19 incidence related to race/ethnicity and socioeconomic factors exist in the hemodialysis population is unknown. Our study involved patients receiving in-center hemodialysis in New York City. We used a validated index of neighborhood social vulnerability, the Social Vulnerability Index (SVI), which comprises 15 census tract-level indicators organized into four themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. We examined the association of race/ethnicity and the SVI with symptomatic COVID-19 between March 1, 2020 and August 3, 2020. COVID-19 cases were ascertained using PCR testing. We performed multivariable logistic regression to adjust for demographics, individual-level social factors, dialysis-related medical history, and dialysis facility factors. Of the 1378 patients on hemodialysis in the study, 247 (17.9%) developed symptomatic COVID-19. In adjusted analyses, non-Hispanic Black and Hispanic patients had significantly increased odds of COVID-19 compared with non-Hispanic White patients. Census tract-level overall SVI, modeled continuously or in quintiles, was not associated with COVID-19 in unadjusted or adjusted analyses. Among non-Hispanic White patients, the socioeconomic status SVI theme, the minority status and language SVI theme, and housing crowding were significantly associated with COVID-19 in unadjusted analyses. Among patients on hemodialysis in New York City, there were substantial racial/ethnic disparities in COVID-19 incidence not explained by neighborhood-level social vulnerability. Neighborhood-level socioeconomic status, minority status and language, and housing crowding were positively associated with acquiring COVID-19 among non-Hispanic Whites. Our findings suggest that socially vulnerable patients on dialysis face disparate COVID-19-related exposures, requiring targeted risk-mitigation strategies.
Sections du résumé
BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected socially disadvantaged populations. Whether disparities in COVID-19 incidence related to race/ethnicity and socioeconomic factors exist in the hemodialysis population is unknown.
METHODS
Our study involved patients receiving in-center hemodialysis in New York City. We used a validated index of neighborhood social vulnerability, the Social Vulnerability Index (SVI), which comprises 15 census tract-level indicators organized into four themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. We examined the association of race/ethnicity and the SVI with symptomatic COVID-19 between March 1, 2020 and August 3, 2020. COVID-19 cases were ascertained using PCR testing. We performed multivariable logistic regression to adjust for demographics, individual-level social factors, dialysis-related medical history, and dialysis facility factors.
RESULTS
Of the 1378 patients on hemodialysis in the study, 247 (17.9%) developed symptomatic COVID-19. In adjusted analyses, non-Hispanic Black and Hispanic patients had significantly increased odds of COVID-19 compared with non-Hispanic White patients. Census tract-level overall SVI, modeled continuously or in quintiles, was not associated with COVID-19 in unadjusted or adjusted analyses. Among non-Hispanic White patients, the socioeconomic status SVI theme, the minority status and language SVI theme, and housing crowding were significantly associated with COVID-19 in unadjusted analyses.
CONCLUSIONS
Among patients on hemodialysis in New York City, there were substantial racial/ethnic disparities in COVID-19 incidence not explained by neighborhood-level social vulnerability. Neighborhood-level socioeconomic status, minority status and language, and housing crowding were positively associated with acquiring COVID-19 among non-Hispanic Whites. Our findings suggest that socially vulnerable patients on dialysis face disparate COVID-19-related exposures, requiring targeted risk-mitigation strategies.
Identifiants
pubmed: 34083409
pii: 00001751-202108000-00024
doi: 10.1681/ASN.2020111606
pmc: PMC8455266
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2048-2056Subventions
Organisme : NIDDK NIH HHS
ID : F32 DK122627
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 by the American Society of Nephrology.
Références
PLoS Med. 2020 Sep 22;17(9):e1003379
pubmed: 32960880
J Am Soc Nephrol. 2020 Aug;31(8):1815-1823
pubmed: 32561681
Ann Epidemiol. 2020 Jul;47:37-44
pubmed: 32419766
J Am Soc Nephrol. 2021 Feb;32(2):385-396
pubmed: 33154174
J Am Soc Nephrol. 2020 Nov;31(11):2517-2521
pubmed: 33077614
Clin J Am Soc Nephrol. 2021 Mar 8;16(3):452-455
pubmed: 33127607
J Am Soc Nephrol. 2020 Sep;31(9):1969-1975
pubmed: 32732391
Patient Educ Couns. 2020 Aug;103(8):1451-1452
pubmed: 32571503
MMWR Morb Mortal Wkly Rep. 2020 Oct 23;69(42):1535-1541
pubmed: 33090977
Clin Infect Dis. 2021 Jul 30;73(Suppl 2):S127-S135
pubmed: 32821935
Lancet. 2020 Oct 24;396(10259):1335-1344
pubmed: 32987007
Clin J Am Soc Nephrol. 2020 May 7;15(5):710-713
pubmed: 32222700
J Am Soc Nephrol. 2020 Jul;31(7):1409-1415
pubmed: 32467113
J Gen Intern Med. 2020 Sep;35(9):2784-2787
pubmed: 32578018
Cureus. 2020 Sep 11;12(9):e10373
pubmed: 33062496
Health Aff (Millwood). 2020 Sep;39(9):1624-1632
pubmed: 32663045
PLoS One. 2020 Dec 3;15(12):e0243028
pubmed: 33270701
Travel Med Infect Dis. 2020 Nov - Dec;38:101904
pubmed: 33137491
Am J Prev Med. 2020 Sep;59(3):317-325
pubmed: 32703701
Kidney Int. 2020 Dec;98(6):1530-1539
pubmed: 32810523