Contagious Disease Inequality

Disparities in COVID-19 hospitalization rates

Azar et al. (2020) use electronic health record data to examine differences in COVID-19 hospitalization rates by patient characteristics. The authors find that:

…compared with non-Hispanic white patients, nonHispanic African American patients had 2.7 times the odds of hospitalization, after adjustment for age, sex, comorbidities, and income.

These findings echo similar COVID-19-related conclusions across California.

California’s [COVID-19] death rate among African Americans is higher than that group’s representation in the population (10 percent mortality versus 6 percent population) and even more disproportionate in some counties. Recent data from Los Angeles County show a 14 percent mortality rate among African Americans, who make up 9 percent of that county’s population.

The authors hypothesize that barriers to access to care or delays in seeking care may lead to African-Americans having more advanced or severe illness at the time of presenting for COVID-19 testing and medical care. One finding that may confirm this suggestion is that African-American patients were more likely to have been tested at a hospital than in the ambulatory care setting. Restricted access to care, however, is likely not due to differences in insurance status as African-American insurance rates are relatively high in California. However, higher cost-sharing may delay access to care as may prior negative interactions with the health care system.

As we continue to fight COVID-19 throughout the country, outreach to encourage early testing for all Americans is vital to insure all patients get the treatment they need.

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