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ABSTRACT: 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.
SUBMITTER: Dalton JE
PROVIDER: S-EPMC8341486 | biostudies-literature |
REPOSITORIES: biostudies-literature