Mechanisms of socioeconomic differences in COVID-19 screening and hospitalizations.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
24
11
2020
accepted:
14
07
2021
entrez:
5
8
2021
pubmed:
6
8
2021
medline:
24
8
2021
Statut:
epublish
Résumé
Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood. To characterize socioeconomic and chronic disease-related mechanisms underlying these differences. Observational cohort study. Outpatient and emergency care. 12900 Cleveland Clinic Health System patients referred for SARS-CoV-2 testing between March 17 and April 15, 2020. Nasopharyngeal PCR test for SARS-CoV-2 infection. Test location (emergency department, ED, vs. outpatient care), COVID-19 symptoms, test positivity and hospitalization among positive cases. We identified six classes of symptoms, ranging in test positivity from 3.4% to 23%. Non-Hispanic Black race/ethnicity was disproportionately represented in the group with highest positivity rates. Non-Hispanic Black patients ranged from 1.81 [95% confidence interval: 0.91-3.59] times (at age 20) to 2.37 [1.54-3.65] times (at age 80) more likely to test positive for the SARS-CoV-2 virus than non-Hispanic White patients, while test positivity was not significantly different across the neighborhood income spectrum. Testing in the emergency department (OR: 5.4 [3.9, 7.5]) and cardiovascular disease (OR: 2.5 [1.7, 3.8]) were related to increased risk of hospitalization among the 1247 patients who tested positive. Constraints on availability of test kits forced providers to selectively test for SARS-Cov-2. Non-Hispanic Black patients and patients from low-income neighborhoods tended toward more severe and prolonged symptom profiles and increased comorbidity burden. These factors were associated with higher rates of testing in the ED. Non-Hispanic Black patients also had higher test positivity rates.
Sections du résumé
BACKGROUND
Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood.
OBJECTIVE
To characterize socioeconomic and chronic disease-related mechanisms underlying these differences.
DESIGN
Observational cohort study.
SETTING
Outpatient and emergency care.
PATIENTS
12900 Cleveland Clinic Health System patients referred for SARS-CoV-2 testing between March 17 and April 15, 2020.
INTERVENTIONS
Nasopharyngeal PCR test for SARS-CoV-2 infection.
MEASUREMENTS
Test location (emergency department, ED, vs. outpatient care), COVID-19 symptoms, test positivity and hospitalization among positive cases.
RESULTS
We identified six classes of symptoms, ranging in test positivity from 3.4% to 23%. Non-Hispanic Black race/ethnicity was disproportionately represented in the group with highest positivity rates. Non-Hispanic Black patients ranged from 1.81 [95% confidence interval: 0.91-3.59] times (at age 20) to 2.37 [1.54-3.65] times (at age 80) more likely to test positive for the SARS-CoV-2 virus than non-Hispanic White patients, while test positivity was not significantly different across the neighborhood income spectrum. Testing in the emergency department (OR: 5.4 [3.9, 7.5]) and cardiovascular disease (OR: 2.5 [1.7, 3.8]) were related to increased risk of hospitalization among the 1247 patients who tested positive.
LIMITATIONS
Constraints on availability of test kits forced providers to selectively test for SARS-Cov-2.
CONCLUSION
Non-Hispanic Black patients and patients from low-income neighborhoods tended toward more severe and prolonged symptom profiles and increased comorbidity burden. These factors were associated with higher rates of testing in the ED. Non-Hispanic Black patients also had higher test positivity rates.
Identifiants
pubmed: 34351971
doi: 10.1371/journal.pone.0255343
pii: PONE-D-20-36807
pmc: PMC8341486
doi:
Types de publication
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0255343Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR002548
Pays : United States
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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