Racial/ethnic disparities in COVID-19 disease burden & mortality among emergency department patients in a safety net health system

ABSTRACT: Background We sought to examine racial and ethnic disparities in test positivity rate and mortality among emergency department (ED) patients tested for COVID-19 within an integrated public health system in Northern California. Methods In this retrospective study we analyzed data from patients seen at three EDs and tested for COVID-19 between April 6 through May 4, 2020. The primary outcome was the test positivity rate by race and ethnicity, and the secondary outcome was 30 day in-hospital mortality. We used multivariable logistic regression to examine associations with COVID-19 test positivity. Results There were 526 patients tested for COVID-19, of whom 95 (18.1%) tested positive. The mean age of patients tested was 54.2 years, 54.7% were male, and 76.1% had at least one medical comorbidity. Black patients accounted for 40.7% of those tested but 16.8% of the positive tests, and Latinx patients accounted for 26.4% of those tested but 58.9% of the positive tests. The test positivity rate among Latinx patients was 40.3% (56/139) compared with 10.1% (39/387) among non-Latinx patients (p < 0.001). Latinx ethnicity was associated with COVID-19 test positivity (adjusted odds ratio 9.6, 95% confidence interval: 3.5–26.0). Mortality among Black patients was higher than non-Black patients (18.7% vs 1.3%, p < 0.001). Conclusion We report a significant disparity in COVID-19 adjusted test positivity rate and crude mortality rate among Latinx and Black patients, respectively. Results from ED-based testing can identify racial and ethnic disparities in COVID-19 testing, test positivity rates, and mortality associated with COVID-19 infection and can be used by health departments to inform policy. Highlights • EDs remain high-volume testing locations for COVID-19 for the most symptomatic patients and disadvantaged communities.• We report a significant disparity in COVID-19 disease burden in the Latinx and Black community.• Latinx ethnicity is associated with higher odds of COVID-19 test positivity in our sample.• EDs are instrumental in detecting outbreaks and disparities in the surveillance of COVID-19 pandemic.

SUBMITTER: Misa N 

PROVIDER: S-EPMC7513762 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature