A model of disparities: risk factors associated with COVID-19 infection

TLDR

By mid‑May 2020, COVID‑19 had surpassed 1.5 million U.S. cases and was rising after state reopenings, yet most studies had focused on clinical risk factors for severe illness and mortality. This study aimed to identify clinical, sociodemographic, and environmental risk factors for initial COVID‑19 infection using a multivariable model on 34,503 Providence Health System cases. The authors employed publicly available data as proxies for social determinants and extracted patient‑level clinical and sociodemographic variables from the electronic medical record to construct the multivariable model.

Abstract

By mid-May 2020, there were over 1.5 million cases of (SARS-CoV-2) or COVID-19 across the U.S. with new confirmed cases continuing to rise following the re-opening of most states. Prior studies have focused mainly on clinical risk factors associated with serious illness and mortality of COVID-19. Less analysis has been conducted on the clinical, sociodemographic, and environmental variables associated with initial infection of COVID-19.A multivariable statistical model was used to characterize risk factors in 34,503cases of laboratory-confirmed positive or negative COVID-19 infection in the Providence Health System (U.S.) between February 28 and April 27, 2020. Publicly available data were utilized as approximations for social determinants of health, and patient-level clinical and sociodemographic factors were extracted from the electronic medical record.Higher risk of COVID-19 infection was associated with older age (OR 1.69; 95% CI 1.41-2.02, p < 0.0001), male gender (OR 1.32; 95% CI 1.21-1.44, p < 0.0001), Asian race (OR 1.43; 95% CI 1.18-1.72, p = 0.0002), Black/African American race (OR 1.51; 95% CI 1.25-1.83, p < 0.0001), Latino ethnicity (OR 2.07; 95% CI 1.77-2.41, p < 0.0001), non-English language (OR 2.09; 95% CI 1.7-2.57, p < 0.0001), residing in a neighborhood with financial insecurity (OR 1.10; 95% CI 1.01-1.25, p = 0.04), low air quality (OR 1.01; 95% CI 1.0-1.04, p = 0.05), housing insecurity (OR 1.32; 95% CI 1.16-1.5, p < 0.0001) or transportation insecurity (OR 1.11; 95% CI 1.02-1.23, p = 0.03), and living in senior living communities (OR 1.69; 95% CI 1.23-2.32, p = 0.001).sisk of COVID-19 infection is higher among groups already affected by health disparities across age, race, ethnicity, language, income, and living conditions. Health promotion and disease prevention strategies should prioritize groups most vulnerable to infection and address structural inequities that contribute to risk through social and economic policy.