Disparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care system
Abstract Background The COVID-19 pandemic has disproportionately impacted racial and ethnic minorities in the United States, including Asian Americans, Native Hawaiians and Pacific Islanders (Asian Americans and NH/PIs). However, few studies have highlighted nor disaggregated these disparities by As...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-023-15089-w |
| _version_ | 1811165660263219200 |
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| author | Jiang Li Davis Chhoa Latha Palaniappan Kevin J. Hays Alice Pressman Nancy E. Wang |
| author_facet | Jiang Li Davis Chhoa Latha Palaniappan Kevin J. Hays Alice Pressman Nancy E. Wang |
| author_sort | Jiang Li |
| collection | DOAJ |
| description | Abstract Background The COVID-19 pandemic has disproportionately impacted racial and ethnic minorities in the United States, including Asian Americans, Native Hawaiians and Pacific Islanders (Asian Americans and NH/PIs). However, few studies have highlighted nor disaggregated these disparities by Asian Americans and NH/PIs ethnic subgroups. Methods This retrospective, cross-sectional observational study aimed to assess variation of Asian Americans and NH/PIs COVID-19 testing and outcomes compared to non-Hispanic Whites (NHW). The study utilized data from the electronic health records (EHR) and the COVID-19 Universal Registry for Vital Evaluations (CURVE) from all patients tested for SARS-CoV-2 (n = 556,690) at a large, health system in Northern and Central California between February 20, 2020 and March 31, 2021. Chi-square tests were used for testing differences in the severity of COVID-19 (hospitalization, ICU admission, death) and patient demographic and clinical characteristics across the Asian Americans and NH/PIs subgroups and NHW. Unadjusted and adjusted Odds Ratios (ORs) were estimated for measuring effect of race ethnicity on severity of COVID-19 using multivariable logistic regression. Results Of the entire tested population, 70,564/556,690 (12.7%) tested positive for SARS-CoV-2. SARS-CoV-2 positivity of Asian subgroups varied from 4% in the Chinese and Korean populations, to 11.2%, 13.5%, and 12.5% for Asian Indian, Filipino, and “other Asian” populations respectively. Pacific Islanders had the greatest subgroup test positivity at 20.1%. Among Asian Americans and NH/PIs patients with COVID-19 disease, Vietnamese (OR = 2.06, 95% CI = 1.30–3.25), “Other Asian” (OR = 2.13, 95% CI = 1.79–2.54), Filipino (OR = 1.78, 95% CI = 1.34–2.23), Japanese (OR = 1.78, 95% CI = 1.10–2.88), and Chinese (OR = 1.73, 95% CI = 1.34–2.23) subgroups had almost double the odds of hospitalization compared to NHW. Pacific Islander (OR = 1.58, 95% CI = 1.19–2.10) and mixed race subgroups (OR = 1.55, 95% CI = 1.10–2.20) had more than one and a half times odds of hospitalization compared to NHW. Adjusted odds of ICU admission or death among hospitalized patients by different Asian subgroups varied but were not statistically significant. Conclusions Variation of COVID-19 testing and hospitalization by Asian subgroups was striking in our study. A focus on the Asian Americans and NH/PIs population with disaggregation of subgroups is crucial to understand nuances of health access, utilization, and outcomes among subgroups to create health equity for these underrepresented populations. |
| first_indexed | 2024-04-10T15:41:24Z |
| format | Article |
| id | doaj.art-d100806eb391443897d0fdaadbd02144 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-10T15:41:24Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-d100806eb391443897d0fdaadbd021442023-02-12T12:25:15ZengBMCBMC Public Health1471-24582023-02-0123111410.1186/s12889-023-15089-wDisparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care systemJiang Li0Davis Chhoa1Latha Palaniappan2Kevin J. Hays3Alice Pressman4Nancy E. Wang5Palo Alto Medical Foundation Research Institute, Center for Health Systems ResearchStanford University School of MedicineStanford University School of Medicine, Primary Care and Population HealthPalo Alto Medical Foundation Research Institute, Center for Health Systems ResearchPalo Alto Medical Foundation Research Institute, Center for Health Systems ResearchDepartments of Emergency Medicine and Pediatrics, Stanford University School of MedicineAbstract Background The COVID-19 pandemic has disproportionately impacted racial and ethnic minorities in the United States, including Asian Americans, Native Hawaiians and Pacific Islanders (Asian Americans and NH/PIs). However, few studies have highlighted nor disaggregated these disparities by Asian Americans and NH/PIs ethnic subgroups. Methods This retrospective, cross-sectional observational study aimed to assess variation of Asian Americans and NH/PIs COVID-19 testing and outcomes compared to non-Hispanic Whites (NHW). The study utilized data from the electronic health records (EHR) and the COVID-19 Universal Registry for Vital Evaluations (CURVE) from all patients tested for SARS-CoV-2 (n = 556,690) at a large, health system in Northern and Central California between February 20, 2020 and March 31, 2021. Chi-square tests were used for testing differences in the severity of COVID-19 (hospitalization, ICU admission, death) and patient demographic and clinical characteristics across the Asian Americans and NH/PIs subgroups and NHW. Unadjusted and adjusted Odds Ratios (ORs) were estimated for measuring effect of race ethnicity on severity of COVID-19 using multivariable logistic regression. Results Of the entire tested population, 70,564/556,690 (12.7%) tested positive for SARS-CoV-2. SARS-CoV-2 positivity of Asian subgroups varied from 4% in the Chinese and Korean populations, to 11.2%, 13.5%, and 12.5% for Asian Indian, Filipino, and “other Asian” populations respectively. Pacific Islanders had the greatest subgroup test positivity at 20.1%. Among Asian Americans and NH/PIs patients with COVID-19 disease, Vietnamese (OR = 2.06, 95% CI = 1.30–3.25), “Other Asian” (OR = 2.13, 95% CI = 1.79–2.54), Filipino (OR = 1.78, 95% CI = 1.34–2.23), Japanese (OR = 1.78, 95% CI = 1.10–2.88), and Chinese (OR = 1.73, 95% CI = 1.34–2.23) subgroups had almost double the odds of hospitalization compared to NHW. Pacific Islander (OR = 1.58, 95% CI = 1.19–2.10) and mixed race subgroups (OR = 1.55, 95% CI = 1.10–2.20) had more than one and a half times odds of hospitalization compared to NHW. Adjusted odds of ICU admission or death among hospitalized patients by different Asian subgroups varied but were not statistically significant. Conclusions Variation of COVID-19 testing and hospitalization by Asian subgroups was striking in our study. A focus on the Asian Americans and NH/PIs population with disaggregation of subgroups is crucial to understand nuances of health access, utilization, and outcomes among subgroups to create health equity for these underrepresented populations.https://doi.org/10.1186/s12889-023-15089-wCOVID-19COVID-19 TestingAsian AmericansEthnic and racial minoritiesMorbidityHospitalization |
| spellingShingle | Jiang Li Davis Chhoa Latha Palaniappan Kevin J. Hays Alice Pressman Nancy E. Wang Disparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care system BMC Public Health COVID-19 COVID-19 Testing Asian Americans Ethnic and racial minorities Morbidity Hospitalization |
| title | Disparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care system |
| title_full | Disparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care system |
| title_fullStr | Disparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care system |
| title_full_unstemmed | Disparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care system |
| title_short | Disparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care system |
| title_sort | disparities in covid 19 testing and outcomes among asian american and pacific islanders an observational study in a large health care system |
| topic | COVID-19 COVID-19 Testing Asian Americans Ethnic and racial minorities Morbidity Hospitalization |
| url | https://doi.org/10.1186/s12889-023-15089-w |
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