Assessing racial and ethnic disparities using a COVID-19 outcomes continuum for New York State

Abstract

Purpose: Heightened COVID-19 mortality among Black non-Hispanic and Hispanic communities (relative to white non-Hispanic) is well established. This study aims to estimate the relative contributions to fatality disparities in terms of differences in SARS-CoV-2 infections, diagnoses, and disease severity.

Methods: We constructed COVID-19 outcome continua (similar to the HIV care continuum) for white non-Hispanic, Black non-Hispanic, and Hispanic adults in New York State. For each stage in the COVID-19 outcome continua (population, infection experience, diagnosis, hospitalization, fatality), we synthesized the most recent publicly available data. We described each continuum using overall percentages, fatality rates, and relative changes between stages, with comparisons between race and ethnicity using risk ratios.

Results: Estimated per-population COVID-19 fatality rates were 0.03%, 0.18%, and 0.12% for white non-Hispanic, Black non-Hispanic, and Hispanic adults, respectively. The 3.48-fold disparity for Hispanic, relative to white, communities was explained by differences in infection experience, whereas the 5.38-fold disparity for non-Hispanic Black, relative to white, communities was primarily driven by differences in both infection experience and in the need for hospitalization, given infection.

Conclusions: These findings suggest the most impactful stages on which to intervene with programs and policies to build COVID-19 health equity.

Keywords: Coronavirus; Epidemics; Epidemiology; Infectious diseases; Race factors; Surveillance.

Fig. 1

Estimated COVID-19 outcomes continuum for adults infected with SARS-CoV-2 through March 29, by race and ethnicity, New York State^a,b. a. The bars represent total individuals at each step (with percentages among the total population). The arrows represent the portion estimated to proceed to the next step. b. Estimates are rounded after calculations conducted at greater precision.