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Health Services Research & Development

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HSR&D In Progress

September 2020

In This Issue: How Research Helps Combat COVID-19
» Table of Contents


Multi-level Factors Underlying VA Racial/Ethnic Disparities in COVID-19 Infection and Complications

Feature Article


Takeaway: This study will identify factors underlying racial/ethnic disparities in COVID-19 among Veterans to help inform VA clinical care and policy strategies that mitigate COVID-19 risks and complications, as well as future approaches to address a possible resurgence.


Racial/ethnic minorities in the U.S., particularly African Americans, are disproportionately affected by the COVID-19 pandemic, with higher infection rates, hospitalizations, and deaths compared with non-Hispanic Whites. For example, African Americans comprise 13% of the U.S. population but account for 33% of COVID-19 hospitalizations. Similarly, among Veterans who rely on VA healthcare, analyses conducted by the Office of Health Equity-QUERI National Partnered Evaluation Center on behalf of VA’s Office of Health Equity (OHE) found racial/ethnic disparities in infection rates, hospitalizations, and age- and-sex-adjusted mortality. For example, controlling for racial/ethnic differences in age and sex distributions, an analysis of VA COVID-19 data showed that adjusted odds ratios for hospitalization were 2.0 for African American Veterans and 1.6 for Hispanic Veterans. Age-and-sex adjusted mortality disparities were identified for African Americans, but not for Hispanics.

Extrapolating from research on racial disparities in the US H1N1 influenza pandemic, racial/ethnic differences in COVID-19 infection and outcomes may be related to differences in healthcare access, underlying health conditions, social circumstances, and the physical environment. A better understanding of the sources of Veteran racial/ethnic disparities in COVID-19 infection and outcomes is required to identify the multiple levels at which actions are needed and at which interventions should be targeted to mitigate the impact of the pandemic. Public health and infectious disease experts caution that the current pandemic is in the first wave of what may become a protracted course. Therefore, it is imperative to address these questions now.

Building on the work on an ongoing QUERI project, this national observational study (August 2020 – January 2022) seeks to identify multi-level factors underlying VA racial/ethnic disparities along the continuum of COVID-19 infection, presentation, and outcomes. This may inform actions at each stage of increased risk. Specific aims are to:

  • Identify geographic, residential, and individual characteristics associated with Veteran racial/ethnic disparities in COVID-19 infection rates.
  • Determine racial/ethnic variations in: COVID-19 stage at presentation, multi-level factors associated with presentation stage, and association of presentation stage with outcomes. Stages may include asymptomatic infection or mild illness, and advanced illness requiring hospitalization.
  • Develop a prognostic prediction tool to risk stratify patients with COVID-19 infection at risk for serious outcomes (e.g., intensive care unit use, intubation, death) to facilitate clinician decision-making about early escalation of clinical care.
  • Estimate the impact of racial/ethnic disparities in response to the pandemic on non-COVID-19 outcomes – and compare racial/ethnic mortality differences for patients with selected chronic conditions before and after the start of the COVID-19 pandemic.

Methods

Investigators will utilize secondary VA and non-VA data sources, including but not limited to U.S. Veterans Eligibility and Trends (USVETS) and CDC county data on infection rates, to identify correlates of VA racial/ethnic disparities. A multi-pronged strategy will be used to identify and assess relationships between individual, residential, and geographic factors and racial/ethnic disparities among Veterans for COVID-19 infection, presentation, and outcomes.

Findings

None at this time.

Anticipated Impact

This study will identify factors underlying racial/ethnic disparities in COVID-19 among Veterans to help inform VA clinical care and policy strategies that mitigate COVID-19 risks and complications, as well as future approaches to address a possible resurgence. These strategies also may be useful in dealing with future pandemics.

Principal Investigator: Donna Washington, MD, MPH, leads the Office of Health Equity-QUERI and is part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA.

Publications

None at this time.

View study abstract

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