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

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

En-Ling Wu  1 , Rebecca N Kumar  2 , W Justin Moore  3 , Gavin T Hall  4 , Indre Vysniauskaite  5 , Kwang-Youn A Kim  6 , Michael P Angarone  7 , Valentina Stosor  7   8 , Michael G Ison  7   8 , Adam Frink Bba  9 , Chad J Achenbach  7   10 , Khalilah L Gates  11
Affiliations
Review

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

En-Ling Wu et al. J Gen Intern Med. 2022 Aug.

Abstract

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.

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Conflict of interest statement

V. Stosor reports research support, paid to Northwestern University, from Eli Lilly and Company. M. G. Ison reports research support, paid to Northwestern University, from GlaxoSmithKline and Regeneron.

Figures

Figure 1
Figure 1
Healthcare system monoclonal antibody delivery. Geospatial representation of the percentage of healthcare system monoclonal antibody referrals administered by ZIP code (a) and region (b) of Cook County, Illinois. Hatch marks represent ZIP codes without referrals. Dots represent and are proportional to the total number of patients referred for monoclonal antibody from each ZIP code or region.
Figure 2
Figure 2
CDC/ATSDR Social Vulnerability Index. Overall Social Vulnerability Index by ZIP code (a) and region (b) of Cook County, Illinois. SVI scores range from 0 (lower vulnerability) to 1 (highest vulnerability).
Figure 3
Figure 3
Healthcare system monoclonal antibody delivery and CDC/ATSDR Social Vulnerability Index. Bivariate chloropleth map of monoclonal antibody delivery and SVI by region. Legend (left) ascribes heat map color scales to the monoclonal antibody delivery rate (X-axis) and SVI score (Y-axis). Regions with the highest delivery rates and lowest social vulnerability are shown in dark red and regions with the lowest delivery rates and highest social vulnerability in light blue.
Figure 4
Figure 4
Healthcare system COVID-19 cases. Total number of healthcare system patients residing in Cook County, Illinois, by ZIP code diagnosed with COVID-19 during the study period.
See this image and copyright information in PMC

References

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