Social Determinants of Health Amplify the Association Between Ethnicity and COVID19: A Retrospective-Cohort study
Keywords:social determinants of health, health care disparities, ethnicity
Background: People in racial and ethnic minority groups have been shown to be at increased risk for a variety of diseases, including COVID-19. However, the role that social needs play in this increased risk has not yet been quantified. Investigating these roles can elicit a greater understanding of how social needs influence the manner in which this disease is contracted and spread.
Methods: A retrospective analysis was conducted of 1,969 Lynn Community Health Center patients. Patients that visited the center between February 1st and July 1st, 2020, tested for COVID-19, and screened for social determinants of health (SDOH) risk factors. Demographics were compared between COVID-19 positive and negative patients. Confounding by age on the association between ethnicity and COVID-19 status was evaluated. A stratified analysis was performed to evaluate the effect modification of SDOH on the relationship between race, ethnicity, and COVID-19 status.
Results: Hispanic patients had 2.93 times the odds of a positive COVID-19 test compared to non-Hispanics (95% CI: 2.37 - 3.64, p<0.0001). With at least one SDOH risk factor, Hispanics had 4.71 times the odds of a positive COVID-19 test relative to non-Hispanics (95% CI: 3.10 - 7.14). With no SDOH risk factors, Hispanics had 2.45 times the odds of a positive COVID-19 test relative to non-Hispanics (95% CI: 1.91 - 3.16). No significant associations were found for race.
Conclusion: Ethnicity had a significant impact on COVID-19 status in our population, where the effect of ethnicity on COVID-19 status was amplified for those with SDOH risk factors.
Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020; 382(10): 929-36.
Centers for Disease Control and Prevention. COVID-19 Overview and Infection Prevention and control Priorities in non-US Healthcare Settings. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/non-us-settings/overview/index.html. Last updated Feb 26, 2021; cited Ap 28, 2021
Rashedi J, Mahdavi Poor B, Asgharzadeh V, Pourostadi M, Samadi Kafil H, Vegari A, Tayebi-Khosroshahi H, Asgharzadeh M. Risk Factors for COVID-19. Infez Med. 2020 Dec 1;28(4):469-474.
Song, H., McKenna, R., Chen, A. T., David, G., & Smith-McLallen, A. The impact of the non-essential business closure policy on Covid-19 infection rates. Int J Health Econ Manag. 2021 Dec;21(4):387-426.
Massachusetts Department of Public Health. COVID-19 Response Reporting. Available from: https://www.mass.gov/info-details/covid-19-response-reporting. Last updated: Daily; cited Apr 28, 2021.
Massachusetts Department of Public Health. Baker-Polio administration announces new initiatives to stop spread of covid-19. Available from: https://www.mass.gov/news/baker-polito-administration-announces-new-initiatives-to-stop-spread-of-covid-19. Last updated: Aug 7, 2020; cited Apr 28, 2021.
Bureau USC. QuickFacts: Lynn, Massachusetts.
Turner-Musa J, Ajayi O, Kemp L. Examining Social Determinants of Health, Stigma, and COVID-19 Disparities. Healthcare (Basel). 2020; 8(2).
Centers for Disease Control and Prevention. CDC COVID Data Tracker. Available from: https://covid.cdc.gov/covid-data-tracker/#demographics. Last updated: Aug 24, 2021; cited Apr 12, 2021.
Centers for Disease Control and Prevention. COVID-19 Hospitalizations and Death by Race/Ethnicity. Available from: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html. Last updated: Jul 16, 2021; cited: Apr 6, 2021.
U.S. Department of Health and Human Services. Healthy People 2030. Available from: https://health.gov/healthypeople/objectives-and-data/social-determinants-health. Last updated: unavailable; cited Aug 25, 2021.
Song R, Hall HI, Harrison KM, Sharpe TT, Lin LS, Dean HD. Identifying the impact of social determinants of health on disease rates using correlation analysis of area-based summary information. Public Health Rep. 2011; 126 Suppl 3: 70-80.
Cockerham WC, Hamby BW, Oates GR. The Social Determinants of Chronic Disease. Am J Prev Med. 2017 Jan; 52(1 Suppl 1): S5–S12.
Butler-Jones D, Wong T. Infectious disease, social determinants and the need for intersectoral action. Can Commun Dis Rep. 2016; 42(Suppl 1): S118-S20.
Singh GK, Daus GP, Allender M, Ramey CT, Martin EK, Perry C, et al. Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935-2016. Int J MCH AIDS. 2017; 6(2): 139-64.
16. Lynn Community Health Center. Lynn Community Health Center General Information. Available from: https://www.lchcnet.org/lynn-community-health-center-general-information. Last updated: unavailable; cited May 6, 2021.
Centers for Medicaid and Medicare Serves. The accountable health communities health-related social needs screening tool. Available from: https://innovation.cms.gov/files/worksheets/ahcm-screeningtool.pdf. Last updated: unavailable; cited Apr 29, 2021.
Billoux A, Verlander, K., Anthony, S., Alley, D. Standardized screening for health-related social needs in clinical settings: The accountable health communities screening tool. NAM Perspectives. 2017.
In: Smedley BD, Stith AY, Nelson AR, editors. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington (DC); 2003
Nelson CC. Using a Social Determinants of Health Summary Measure to Predict General Health Status in the BRFSS. American Journal of Health Promotion. 2021 Nov.
United States Bureau of Labor Statistics. Labor force characteristics by race and ethnicity 2018.
Cox R, Seva, R., Benjamin, H., Suzanne, W. Measuring population estimates of housing insecurity in the United States: A comprehensive approach. CESR - Schaeffer Working Paper. 2017.
Centers for Disease Control. Communities, Schools, Workplaces, & Events: 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2201-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html#fn17. Last updated: Apr 19, 2021; cited: Apr 8, 2021.
Macias Gil R, Marcelin JR, Zuniga-Blanco B, Marquez C, Mathew T, Piggott DA. COVID-19 Pandemic: Disparate Health Impact on the Hispanic/Latinx Population in the United States. J Infect Dis. 2020 Oct 13;222(10):1592-1595.
Centers for Disease Control. Considerations for owners and operators of multifamily housing including populations at increased risk for complications from covid-19. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/multifamily-housing.html. Last updated: May 5, 2021; cited: May 6, 2021.
Rogers TN, Rogers CR, VanSant-Webb E, Gu LY, Yan B, Qeadan F. Racial Disparities in COVID-19 Mortality Among Essential Workers in the United States. World Med Health Policy. 2020 Aug 5;10.1002/wmh3.358.
Stringhini S, Carmeli C, Jokela M, Avendano M, Muennig P, Guida F, et al. Socioeconomic status and the 25 x 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1.7 million men and women. Lancet. 2017 Mar 25;389(10075):1229-1237.
Vukojevic M, Zovko A, Talic I, Tanovic M, Resic B, Vrdoljak I, et al. Parental Socioeconomic Status as a Predictor of Physical and Mental Health Outcomes in Children - Literature Review. Acta Clin Croat. 2017 Dec;56(4):742-748.
Vrijheid M, Dolk H, Stone D, Abramsky L, Alberman E, Scott JE. Socioeconomic inequalities in risk of congenital anomaly. Arch Dis Child. 2000 May;82(5):349-52.
Walker RJ, Smalls BL, Campbell JA, Strom Williams JL, Egede LE. Impact of social determinants of health on outcomes for type 2 diabetes: a systematic review. Endocrine. 2014 Sep;47(1):29-48.
Coffey PM, Ralph AP, Krause VL. The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review. PLoS Negl Trop Dis. 2018 Jun 13;12(6):e0006577 7.
Pellowski JA, Kalichman SC, Matthews KA, Adler N. A pandemic of the poor: social disadvantage and the U.S. HIV epidemic. Am Psychol. May-Jun 2013;68(4):197-209.
Grantz KH, Rane MS, Salje H, Glass GE, Schachterle SE, Cummings DA. Disparities in influenza mortality and transmission related to sociodemographic factors within Chicago in the pandemic of 1918. Proc Natl Acad Sci U S A. 2016 Nov 29;113(48):13839-13844.
Centers for Disease Control. Demographic Trends of COVID-19 cases and deaths in the US reported to CDC. Available from: https://covid.cdc.gov/covid-data-tracker/#demographics. Last updated: Aug 24, 2021; cited Aug 25, 2021.
Centers for Medicare and Medicaid Services. Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes. Available from: https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf. Last updated: Mar 13, 2021; cited Aug 25, 2021.
Commonwealth of Massachusetts. Order extending the temporary closure of all public and private elementary and secondary schools. Available from: https://www.mass.gov/doc/april-21-2020-school-closure-extension-order/download. Last updated: Apr 21, 2020; cited Aug 25, 2021.
Auger KA, Shah SS, Richardson T, et al. Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US. JAMA. 2020 Sep 1;324(9):859-870.
Brauner JM, Mindermann S, Sharma M, Johnston D, Salvatier J, Gaven?iak T, et al. Inferring the effectiveness of government interventions against COVID-19. Science. 2021 Feb 19;371(6531):eabd9338.
Yang B, Huang AT, Garcia-Carreras B, Hart WE, Staid A, Hitchings MD, et al. Effect of specific non-pharmaceutical intervention policies on SARS-CoV-2 transmission in the counties of the United States. Nat Commun. 2021 Jun 11;12(1):3560.
Lee J, Schram A, Riley E, Harris P, Baum F, Fisher M, et al. Addressing Health Equity Through Action on the Social Determinants of Health: A Global Review of Policy Outcome Evaluation Methods. Int J Health Policy Manag. 2018 Jul 1;7(7):581-592
Oregon leverages Medicaid to address social determinants of health and health equity. Center for Health Systems Effectiveness, Oregon Health & Science University; 2021.
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