Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study

Autoři: Christopher T. Rentsch aff001;  Farah Kidwai-Khan aff001;  Janet P. Tate aff001;  Lesley S. Park aff004;  Joseph T. King, Jr aff001;  Melissa Skanderson aff001;  Ronald G. Hauser aff001;  Anna Schultze aff002;  Christopher I. Jarvis aff002;  Mark Holodniy aff007;  Vincent Lo Re, III aff009;  Kathleen M. Akgün aff001;  Kristina Crothers aff011;  Tamar H. Taddei aff001;  Matthew S. Freiberg aff013;  Amy C. Justice aff001
Působiště autorů: VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America aff001;  Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom aff002;  Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America aff003;  Stanford Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, United States of America aff004;  Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States of America aff005;  Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America aff006;  VA Palo Alto Health Care System, US Department of Veterans Affairs, Palo Alto, California, United States of America aff007;  Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America aff008;  Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America aff009;  Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America aff010;  VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington, United States of America aff011;  Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America aff012;  Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, Tennessee, United States of America aff013;  Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America aff014;  Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, United States of America aff015
Vyšlo v časopise: Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study. PLoS Med 17(9): e32767. doi:10.1371/journal.pmed.1003379
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003379



There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVID-19 testing (i.e., who received testing and who tested positive) and subsequent mortality in the largest integrated healthcare system in the United States.

Methods and findings

This retrospective cohort study included 5,834,543 individuals receiving care in the US Department of Veterans Affairs; most (91%) were men, 74% were non-Hispanic White (White), 19% were non-Hispanic Black (Black), and 7% were Hispanic. We evaluated associations between race/ethnicity and receipt of COVID-19 testing, a positive test result, and 30-day mortality, with multivariable adjustment for a wide range of demographic and clinical characteristics including comorbid conditions, health behaviors, medication history, site of care, and urban versus rural residence. Between February 8 and July 22, 2020, 254,595 individuals were tested for COVID-19, of whom 16,317 tested positive and 1,057 died. Black individuals were more likely to be tested (rate per 1,000 individuals: 60.0, 95% CI 59.6–60.5) than Hispanic (52.7, 95% CI 52.1–53.4) and White individuals (38.6, 95% CI 38.4–38.7). While individuals from minority backgrounds were more likely to test positive (Black versus White: odds ratio [OR] 1.93, 95% CI 1.85–2.01, p < 0.001; Hispanic versus White: OR 1.84, 95% CI 1.74–1.94, p < 0.001), 30-day mortality did not differ by race/ethnicity (Black versus White: OR 0.97, 95% CI 0.80–1.17, p = 0.74; Hispanic versus White: OR 0.99, 95% CI 0.73–1.34, p = 0.94). The disparity between Black and White individuals in testing positive for COVID-19 was stronger in the Midwest (OR 2.66, 95% CI 2.41–2.95, p < 0.001) than the West (OR 1.24, 95% CI 1.11–1.39, p < 0.001). The disparity in testing positive for COVID-19 between Hispanic and White individuals was consistent across region, calendar time, and outbreak pattern. Study limitations include underrepresentation of women and a lack of detailed information on social determinants of health.


In this nationwide study, we found that Black and Hispanic individuals are experiencing an excess burden of SARS-CoV-2 infection not entirely explained by underlying medical conditions or where they live or receive care. There is an urgent need to proactively tailor strategies to contain and prevent further outbreaks in racial and ethnic minority communities.

Klíčová slova:

Alcohol consumption – COVID 19 – Hispanic people – Medical risk factors – Public and occupational health – SARS CoV 2 – United States – Virus testing


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Článek vyšel v časopise

PLOS Medicine

2020 Číslo 9

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