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Publication Briefs
 

Nationwide Study Finds Blacks and Hispanics Twice as Likely as White Veterans to Test Positive for COVID-19


BACKGROUND:
There is accumulating evidence that racial and ethnic minority communities in the US are experiencing a disproportionate burden of COVID-19. However, studies to date have focused on those who tested positive or hospitalized patients. This retrospective cohort study examined racial and ethnic disparities in patterns of COVID-19 testing (i.e., who received testing and who tested positive) and subsequent 30-day mortality for Veterans receiving VA healthcare (all testing and services in this study were provided within VA). Investigators adjusted their results for other patient demographics, urban/rural residence, geographic region, site of care, and clinical characteristics (e.g., cancer, asthma, diabetes, COPD, alcohol use disorder). They also assessed potential variations in racial/ethnic disparities by calendar time, U.S. region, and outbreak patterns based on site-level percentages of positive tests per month. Using VA data, investigators identified 5.8 million Veterans (74% non-Hispanic White, 19% non-Hispanic Black, and 7% Hispanic) in VA care. Of this study cohort, 254,595 Veterans were tested for COVID-19 between February 8 and July 22, 2020, of whom 16,317 tested positive and 1,057 died.

FINDINGS:

  • Black Veterans were more likely to be tested (rate per 1,000 patients, 60.0) than Hispanic (52.7) or White Veterans (38.6).
  • Among those tested, both Black and Hispanic Veterans were twice as likely to test positive than White Veterans, even after accounting for all adjusting variables.
  • The disparity between Black and White Veterans in testing positive slightly decreased over the study period – and was highest in the Midwest compared to other regions. The disparity between Hispanic and White Veterans was consistent across time, geographic region, and outbreak pattern.
  • Among those who tested positive for COVID-19, there were no other observed differences in 30-day mortality by race/ethnicity group.

IMPLICATIONS:

  • Findings suggest a substantial excess burden of COVID-19 infection in U.S. minority communities. Understanding what is driving these disparities is vital so that state- and local-level strategies can be tailored to curb the disproportionate epidemics in racial and ethnic minority communities.

LIMITATIONS:

  • Beyond adjusting for rural/urban location and site of care, investigators were unable to explore likely social determinants of the pronounced differential burden of COVID-19 among minority individuals.

AUTHOR/FUNDING INFORMATION:
Drs. Rentsch, Kidwai-Khan, Tate, King, Skanderson, Hauser, Taddei, and Justice are part of the VA Connecticut Healthcare System; Dr. Justice also is part of HSR&D’s Pain Research, Informatics, Multi-morbidities, and Education Center in West Haven, CT. Dr. Holodniy is part of the VA Palo Alto Health Care System; Dr. Crothers is part of the VA Puget Sound Health Care System; and Dr. Freiberg is part of the Tennessee Valley Healthcare System.


Rentsch C, Kidwai-Khan F, Tate J, Park L, King Jr. J, Skanderson M, Hauser R, Schultze A, Jarvis C, Holodniy M, Lo Re III V, Akgûn K, Crothers K, Taddei T, Freiberg M, and Justice A. Patterns of COVID-19 Testing and Mortality by Race and Ethnicity among United States Veterans: A Nationwide Cohort Study. PLoS Medicine. September 22, 2020;17(9):e1003379.

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HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.


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