U.S. COVID-19 Test Results Strongly Correlate with Race/Ethnicity, Income
- In this study, Massachusetts General Hospital physicians analyzed data on 394,536 outpatients and inpatients who were tested for COVID-19 between March 3 and December 14, 2020; the number of positive tests was 29,977 (7.6%)
- Latinx and Black people were more than twice as likely as white people to test positive (17.2% vs. 11.9% vs. 5.6%; P<0.0001 for both comparisons)
- Individuals living in neighborhoods with a poverty rate >15% were more than three times as likely to test positive than those in neighborhoods with a poverty rate ≤5% (13.8% vs. 4.4%; P<0.0001)
- Individuals in neighborhoods with >20% of people working in the service sector were more than three times as likely to test positive than those in neighborhoods with ≤10% service workers (13.4% vs. 4.2%; P<0.0001)
Socioeconomic disparities in COVID-19 rates and deaths have been well documented, but previous research has been limited to hospitalized patients or has been unable to distinguish between group and individual risk factors.
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Marcela del Carmen, MD, the chief medical officer of Massachusetts General Physicians Organization and Massachusetts General Hospital, a gynecologic oncologist in the Department of Obstetrics and Gynecology, a clinician in the Center for Gynecologic Oncology in the Mass General Cancer Center, and Jason H. Wasfy, MD, MPhil, medical director of the Massachusetts General Physicians Organization and director of Quality and Analytics at the Cardiology Division, and colleagues used a detailed database to assess risk factors for positive COVID-19 tests among both inpatients and outpatients.
The researchers analyzed data on 394,536 people who were tested between March 3 and December 14, 2020. They received care at Mass General or its affiliated hospitals, urgent care centers, community health centers or community physician offices.
The database was used to determine each individual's sex, race/ethnicity, insurance status and zip code. The study team then used the 2015–2019 American Community Survey to impute information about each zip code: household income, unemployment rate, poverty rate and proportion of workers in service occupations.
29,977 individuals (7.6%) had positive tests.
- Sex—Males had more positive tests than females (8.2% vs. 7.2%; P<0.0001)
- Race/ethnicity—Latinx and Black individuals had more positive tests than white individuals (17.2% vs. 11.9% vs. 5.6%; P<0.0001 for both comparisons)
- Insurance status—Individuals on Medicaid had more positive tests than commercially insured individuals (14.2% vs. 6.8%, p< 0.0001)
- Household income—Individuals living in neighborhoods with an estimated median household income of ≤$70,000/year had more positive tests than those in neighborhoods with >$100,000/year (13.3% vs. 4.7%; P<0.0001)
- Unemployment—Individuals in neighborhoods with a pre-pandemic unemployment rate >5% had more positive tests than those in neighborhoods with a rate of ≤3.5% (10.7% vs. 5.8%; P<0.0001)
- Poverty—Individuals in neighborhoods with a poverty rate >15% had more positive tests than those in neighborhoods with a rate of ≤5% (13.8% vs. 4.4%; P<0.0001)
- Occupation—Individuals in neighborhoods with >20% of people working in the service sector had more positive tests than those in neighborhoods with ≤10% (13.4% vs. 4.2%; P<0.0001)
These results suggest societal inequities are playing a major role in the consequences of the COVID-19 pandemic in the U.S. The specific results may not be generalizable to other health care systems; for example, only 7% of this cohort were Black people, 1.4% were Latinx people and 0.5% was uninsured.
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