Disparities in COVID-19 Monoclonal Antibody Delivery: a Retrospective Cohort Study

J Gen Intern Med. 2022 Aug;37(10):2505-2513. doi: 10.1007/s11606-022-07603-4. Epub 2022 Apr 25.


Background: Disparities in access to anti-SARS-CoV-2 monoclonal antibodies have not been well characterized.

Objective: We sought to explore the impact of race/ethnicity as a social construct on monoclonal antibody delivery.

Design/patients: Following implementation of a centralized infusion program at a large academic healthcare system, we reviewed a random sample of high-risk ambulatory adult patients with COVID-19 referred for monoclonal antibody therapy.

Main measures: We examined the relationship between treatment delivery, race/ethnicity, and other demographics using descriptive statistics, binary logistic regression, and spatial analysis.

Key results: There was no significant difference in racial composition between patients who did (n = 25) and patients who did not (n = 378) decline treatment (p = 0.638). Of patients who did not decline treatment, 64.8% identified as White, 14.8% as Hispanic/Latinx, and 11.1% as Black. Only 44.6% of Hispanic/Latinx and 31.0% of Black patients received treatment compared to 64.1% of White patients (OR 0.45, 95% CI 0.25-0.81, p = 0.008, and OR 0.25, 95% CI 0.12-0.50, p < 0.001, respectively). In multivariable analysis including age, race, insurance status, non-English primary language, county Social Vulnerability Index, illness severity, and total number of comorbidities, associations between receiving treatment and Hispanic/Latinx or Black race were no longer statistically significant (AOR 1.32, 95% CI 0.69-2.53, p = 0.400, and AOR 1.34, 95% CI 0.64-2.80, p = 0.439, respectively). However, patients who were uninsured or whose primary language was not English were less likely to receive treatment (AOR 0.16, 95% CI 0.03-0.88, p = 0.035, and AOR 0.37, 95% CI 0.15-0.90, p = 0.028, respectively). Spatial analysis suggested decreased monoclonal antibody delivery to Cook County patients residing in socially vulnerable communities.

Conclusions: High-risk ambulatory patients with COVID-19 who identified as Hispanic/Latinx or Black were less likely to receive monoclonal antibody therapy in univariate analysis, a finding not explained by patient refusal. Multivariable and spatial analyses suggested insurance status, language, and social vulnerability contributed to racial disparities.

Keywords: COVID-19; SARS-CoV-2; Social Vulnerability Index; monoclonal antibody; racial/ethnic disparities.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Antibodies, Monoclonal
  • Black or African American
  • COVID-19* / epidemiology
  • COVID-19* / ethnology
  • COVID-19* / therapy
  • Healthcare Disparities*
  • Hispanic or Latino
  • Humans
  • Retrospective Studies
  • White


  • Antibodies, Monoclonal