Persistence of Disparities Among Racially/Ethnically Marginalized Groups in the Coronavirus Disease 2019 Pandemic Regardless of Statewide Shelter-in-Place Policies: An Analysis From Northern California

Abstract

To measure disparities in coronavirus disease 2019 (COVID-19) hospitalization and intensive care unit (ICU) transfer among racially/ethnically marginalized groups before and after implementation of the California statewide shelter-in-place (SIP) policy, we conducted a retrospective cohort study within a health-care system in California. COVID-19 patients diagnosed from January 1, 2020, to August 31, 2020, were identified from electronic health records. We examined hospitalizations and ICU transfers by race/ethnicity and pandemic period using logistic regression. Among 16,520 people with COVID-19 (mean age = 46.6 (standard deviation, 18.4) years; 54.2% women), during the post-SIP period, patients were on average younger and a larger proportion were Hispanic. In adjusted models, odds of hospitalization were 20% lower post-SIP as compared with the SIP period, yet all non-White groups had higher odds (odds ratios = 1.6-2.1) than non-Hispanic White individuals, regardless of period. Among hospitalized patients, odds of ICU transfer were 33% lower post-SIP than during SIP. Hispanic and Asian patients had higher odds than non-Hispanics. Disparities in hospitalization persisted and ICU risk became more pronounced for Asian and Hispanic patients post-SIP. Policy-makers should consider ways to proactively address racial/ethnic inequities in risk when considering future population-level policy interventions for public health crises.

Keywords: coronavirus disease 2019; health disparities; health policy.