Aggregated Data Can Mask COVID-19 Rates in Vulnerable Communities
Key findings
- This prospective cohort study, conducted from March 6 to May 4, 2020, at Massachusetts General Hospital, followed 136 women (54 Latina, 82 non-Latina) who tested positive for SARS-CoV-2 while pregnant or within two weeks postpartum
- 39 Latina women tested positive compared with 22 non-Latina women (P < .001)
- Among non-Latina women, there was a plateau in the cumulative percentage of women who tested positive, but among Latinas, the percentage continued to rise throughout the study period
- Although Latina women represent just 18% of the population in the catchment area for the Mass General obstetric service, they accounted for 62% of all pregnant women hospitalized for COVID-19
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The spread of the novel coronavirus, SARS-CoV-2, has not affected all U.S. communities equally. Within the field of obstetrics and gynecology, researchers have noted racial and ethnic inequities in maternal mortality and severe maternal morbidity related to COVID-19.
Ilona Goldfarb, MD, MPH, maternal-fetal medicine specialist in the Department of Obstetrics and Gynecology at Massachusetts General Hospital, and colleagues, have added to that evidence base by documenting disparities between Latina and non-Latina pregnant women in the prevalence of SARS-CoV-2 infection and the severity of COVID-19. Their findings appear in Obstetrics & Gynecology.
Study Details
The prospective cohort study was conducted at Mass General from March 6 to May 4, 2020, a period that included the peak incidence of COVID-19 in the Boston area. The study subjects were 192 women (65 Latina, 127 non-Latina) who reported COVID-19 symptoms while pregnant or within two weeks postpartum.
Women who also had epidemiologic risk factors were tested for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction (at that time the hospital had an insufficient testing capacity for all symptomatic women).
Prevalence of Infection
136 women (71%) were tested:
- 54 Latina, of whom 39 (72%) tested positive
- 82 non-Latina, of whom 22 (27%) tested positive
The difference between groups was statistically significant (P < .001).
Among non-Latina women, there was a plateau in the cumulative percentage of women who tested positive, but among Latinas, the percentage continued to rise throughout the study period.
Disease Severity
13 of the 39 Latina women were hospitalized, including five admitted to the ICU, where four were intubated. Eight of the 22 non-Latina women were hospitalized, including one admitted to the ICU, who was not intubated. There were no deaths.
Conclusion
Latina women represent just 18% of the population in the hospital's catchment area, yet they accounted for 62% (13 of 21) of pregnant women hospitalized for COVID-19. This study demonstrates the urgent need to slow the spread of SARS-CoV-2 in Latinx communities, but language barriers, jobs without sick pay or insurance and fear of immigration officials may keep individuals from seeking medical attention.
Another implication is that when institutions or regions gather data about COVID-19, detailed demographic information is needed. Otherwise, the aggregated results may seem overly optimistic, suggesting the SARS-CoV-2 infection curve has been flattened for all populations.
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