Accounting for Social Risk Does not Eliminate Race/Ethnic Disparities in COVID-19 Infection Among Insured Adults: a Cohort Study

Abstract

Background: Communities of color have been disproportionately impacted by the COVID-19 epidemic in the USA.

Objectives: To examine the relationship of self-reported social health needs with SARS-COV-2 infection by race/ethnicity among insured adults with access to high-quality health care.

Design and participants: A prospective cohort study of 26,741 adult Kaiser Permanente Northern California members insured by Medicaid and 58,802 Kaiser Permanente Colorado members insured by Medicare Advantage who completed social risk assessments prior to the onset of the COVID-19 pandemic.

Main measures: We examined the independent relationships of demographic, medical, and social factors on SARS-COV-2 testing and positivity between March 1, 2020, and November 30, 2020, by race/ethnicity.

Key results: Findings were similar in the two cohorts, with Latino (16-18%), Asian (11-14%), and Black (11-12%) members having the highest prevalence of SARS-COV-2 infection (ORs adjusted for age, gender, and use of interpreter ranging from 1.68 to 2.23 compared to White member [7-8%], p < 0.001). Further adjustment for medical comorbidity (e.g., obesity, diabetes, chronic lung disease); neighborhood measures; and self-reported social risk factors (e.g., trouble paying for basics, food insecurity, housing concerns, transportation barriers) did not appreciably change these results.

Conclusions: Compared to non-Latino White members, members of other race/ethnic groups had higher positivity rates that were only minimally reduced after controlling for medical and neighborhood conditions and self-reported social risk factors. These findings suggest that traditional infection transmission factors such as essential work roles and household size that have disproportionate representation among communities of color may be important contributors to SARS-COV-2 infection among insured adults.

Keywords: COVID-19; Disparity; Ethnicity; Race; Socioeconomic factors.

Figure 1.

COVID-19 testing and positivity rates by race/ethnicity. A Medicaid—Northern California Cohort (n=26,741 Total; n=7,538 Tested). B Medicare—Colorado Cohort (n= 58,802 Total; n=8,254 Tested). Testing for COVID-19 includes patients with a diagnostic COVID-19 lab result or an encounter with a COVID-19 screening or lab confirmed COVID-19 diagnosis. “*” indicates unadjusted p-value <0.05 in comparison to the White referent group.