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Comparative Study
. 2023 Sep 18;77(6):827-838.
doi: 10.1093/cid/ciad266.

Vaccination Status and Trends in Adult Coronavirus Disease 2019-Associated Hospitalizations by Race and Ethnicity: March 2020-August 2022

Jean Y Ko  1   2 , Huong Pham  1 , Onika Anglin  1 , Shua J Chai  3   4 , Nisha B Alden  5 , James Meek  6 , Evan J Anderson  7   8   9 , Andy Weigel  10 , Alexander Kohrman  11 , Ruth Lynfield  12 , Dominic Rudin  13 , Grant Barney  14 , Nancy M Bennett  15 , Laurie M Billing  16 , Melissa Sutton  17 , H Keipp Talbot  18 , Ashley Swain  19 , Fiona P Havers  1   2 , Christopher A Taylor  1 ; COVID-NET Surveillance Team
Collaborators, Affiliations
Comparative Study

Vaccination Status and Trends in Adult Coronavirus Disease 2019-Associated Hospitalizations by Race and Ethnicity: March 2020-August 2022

Jean Y Ko et al. Clin Infect Dis. .

Abstract

Background: We sought to determine whether race/ethnicity disparities in severe coronavirus disease 2019 (COVID-19) outcomes persist in the era of vaccination.

Methods: Population-based age-adjusted monthly rate ratios (RRs) of laboratory-confirmed COVID-19-associated hospitalizations were calculated among adult patients from the COVID-19-Associated Hospitalization Surveillance Network, March 2020 - August 2022 by race/ethnicity. Among randomly sampled patients July 2021 - August 2022, RRs for hospitalization, intensive care unit (ICU) admission, and in-hospital mortality were calculated for Hispanic, Black, American Indian/Alaskan Native (AI/AN), and Asian/Pacific Islander (API) persons vs White persons.

Results: Based on data from 353 807 patients, hospitalization rates were higher among Hispanic, Black, and AI/AN vs White persons March 2020 - August 2022, yet the magnitude declined over time (for Hispanic persons, RR = 6.7; 95% confidence interval [CI], 6.5-7.1 in June 2020 vs RR < 2.0 after July 2021; for AI/AN persons, RR = 8.4; 95% CI, 8.2-8.7 in May 2020 vs RR < 2.0 after March 2022; and for Black persons RR = 5.3; 95% CI, 4.6-4.9 in July 2020 vs RR < 2.0 after February 2022; all P ≤ .001). Among 8706 sampled patients July 2021 - August 2022, hospitalization and ICU admission RRs were higher for Hispanic, Black, and AI/AN patients (range for both, 1.4-2.4) and lower for API (range for both, 0.6-0.9) vs White patients. All other race and ethnicity groups had higher in-hospital mortality rates vs White persons (RR range, 1.4-2.9).

Conclusions: Race/ethnicity disparities in COVID-19-associated hospitalizations declined but persist in the era of vaccination. Developing strategies to ensure equitable access to vaccination and treatment remains important.

Keywords: COVID-19–associated hospitalizations; race and ethnicity; trends.

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Conflict of interest statement

Potential conflicts of interest. E. J. A. reports clinical trial grants from Regeneron, Pfizer, Merck, PaxVax, Micron, Sanofi-Pasteur, Janssen, MedImmune, Moderna, and GSK; consulting fees from Pfizer, Sanofi-Pasteur, GSK, Janssen, Moderna, and Medscape; personal fees from Kentucky Bioprocessing, Inc, and Sanofi-Pasteur, for participation on data and safety monitoring boards; personal fees from WCG and ACI Clinical for participation on a data adjudication board; and is a current employee of Moderna, outside the submitted work. His institution has received funding from the National Institutes of Health to conduct clinical trials of COVID-19 vaccines. A. W. reports grants from the CDC/Council of State and Territorial Epidemiologists for flu surveillance (eg, Youth in Agriculture, Enhancing Laboratory Capacity). L. M. B. reports grants from the CDC via Epidemiology and Laboratory Capacity and Immunizations and Vaccines for Children. R. L. reports a role as associate editor for the American Academy of Pediatrics Red (Report on the Committee on Infectious Diseases). All remaining authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
COVID-19–Associated Hospitalization Surveillance Network flow diagram. Abbreviations: AI/AN, American Indian/Alaskan Native; API, Asian/Pacific Islander; COVID-19, coronavirus disease 2019; NH, non-Hispanic; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. aWeighted %. bIndividual vaccinated with primary series only defined as having received 2 doses of a 2-dose series or 1 dose of a single-dose series ≥14 days before a positive SARS-CoV-2 test. Individuals were considered boosted if they were vaccinated with their primary series and received an additional dose.
Figure 2.
Figure 2.
A, Age-adjusted monthly COVID-19–associated hospitalization ratesa by race and ethnicity, COVID-NET, 1 March 2020–31 August 2022. B, Age-adjusted monthly COVID-19–associated hospitalization RRsb,c,d by race and ethnicity, COVID-NET, 1 March 2020–31 August 2022. Abbreviations: AI/AN, American Indian/Alaskan Native; COVID-19, coronavirus disease 2019; COVID-NET, COVID-19–Associated Hospitalization Surveillance Network; RR, rate ratio. aRates exclude persons aged <18 years, hospitalizations with missing or unknown race, or more than 1 race. bNon-Hispanic White persons is the reference group for RR calculation. cHospitalization RR was highest for Hispanic persons in June 2020 (RR = 6.7; 95% CI, 6.5–7.0; P < .001); for AI/AN persons in April 2020 (RR = 8.4; 95% CI, 8.2–8.7; P < .001); and for Black persons in May 2020 (RR = 5.3; 95% CI, 4.6–4.9; P < .001) and remained greater but smaller in magnitude over time; for Hispanic persons after July 2021 (RR < 2.0: P <.001); for AI/AN persons after November 2021(RR < 3.0; P < .001); and for Black persons after July 2021 (RR < 3.0; P <.001). dHospitalization rates for non-Hispanic Asian or Pacific Islander persons consistently lower than for non-Hispanic White persons after September 2020 (RR < 1).
Figure 3.
Figure 3.
Percentage of coronavirus disease 2019–associated hospitalizations vaccinated with primary series and boosteda by race/ethnicity, July 2021–August 2022. Abbreviation: SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. aIndividual vaccinated with primary series only defined as having received 2 doses of a 2--dose series or 1 dose of a single-dose series ≥14 days before a positive SARS-CoV-2 test. Individuals were considered boosted if they were vaccinated with their primary series and received an additional dose.
See this image and copyright information in PMC

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